肱骨髁间骨折术后疗效影响因素的相关分析

目的探讨肱骨髁间骨折术后疗效的影响因素。方法对切开复位内固定治疗的66例肱骨髁间骨折患者临床资料进行分析,采用Cassebaum标准对术后肘关节功能评分,并选取临床可能影响手术疗效的因素,如年龄、切口的选择、手术时间、骨折类型、骨折复位质量以及术后功能锻炼的时间等作为指标进行分组、赋值及单因素筛选和多因素Logistic回归分析。结果66例随访5个月~4年,评分结果：优23例,良25例,可15例,差3例,优良率72.7%。钢板内固定组和克氏针固定组优良率分别为81.6%和53%;肱三头肌舌状瓣入路优良率70%,尺骨鹰嘴截骨入路优良率76.9%;术后50例解剖复位（优良率90%）,16例复位欠满意（优良率45.4%）;伤后24 h内手术优良率为73%,24h后为72.4%;年龄组：〈40岁与≥40岁的优良率分别为73.1%和72%;功能锻炼4周内与4周后组优良率分别为89.1%、65.6%。单因素和多因素Logistic回归分析显示不同手术方式（χ^2=7.606,P=0.006）、骨折复位质量情况（χ^2=31.023,P=0.000）以及术后功能锻炼的时间（χ^2=11.505,P=0.001）是影响肱骨髁间骨折术后疗效主要因素。结论影响肱骨髁间骨折手术疗效的因素有手术方式、骨折复位质量和术后功能锻炼的时间;根据骨折类型使用钢板坚强内固定、解剖复位骨折和早期渐进合理功能锻炼可获得较好疗效。

Analysis of correlative factors influencing the curative effect of intercondylar fracture of humerus

Objective To explore the correlative factors influencing the operative results of intercondylar fracture of humerus. Methods The data of 66 patients with intercondylar fractures of humerus treated by open reduction and internal fixation were analyzed. The functions of elbow were evaluated by the cassebaum elbow score. According to possible related factors such as the age, the approach of operation, the time to surgery after injury, the degree of fracture, the way of internal fixation, the quality of fracture reduction and the time to exercise, the patients were grouped. All data were analyzed by single factor analysis and Muhiple-factors Logistic regression. Results All cases were followed up for 5 months to four years. According to Cassebaum elbow score, 23 cases were excellent, 25 good, 15 fair and 3 were poor. The excellent and good rate was 72.7%. The excellent and good rate in plate group and in Kirschner group were 81.6% and 53% ; 76. 9 % and 70% in approach of osteotomy of olecranon and splitting tricepes respectively; In 50 cases with anatomic redaction, the excellent and good rate was 90% , and in 16 with imperfect group, it was 45.4%. It was 73% in cases treated in 24 h, and 72.4% in cases treated after 24 h. In the age 〈40 years old and ≥40 years old group, the excellent and good rates were 73. 1% and 72% ; The excellent and good rates was 89. 1% and 65.6% in the group of exercising before four weeks and after respectively. Single factor analysis and multiple - factors Logistic regression showed that the curative effect of intercondylar fracture of humerus were associated with the way of internal fixation （χ^2= 7. 606, P = 0. 006） , the quality of fl＇acture reduction （χ^2 = 31. 023, P = 0. 000 ） and the time to exercise （χ^2 = 11. 505, P = 0. 001 ）. Conclusions The main factors influencing the operative results of intercondylar fracture of humerus are the way of internal fixation, quality of reduction and the time to exercise early after operation. To achieve satisfactory treatment