胫骨平台伴髁间棘骨折术后关节功能康复的影响因素分析

目的 Logistics回归分析胫骨平台伴髁间棘骨折患者术后关节功能康复效果的影响因素，建立风险模型预测，进一步为术后膝关节功能康复奠定基础。 方法 选取胫骨平台伴髁间棘骨折患者328例作为研究对象，美国特种外科医院膝关节评分（Hospital for Special Surgery Knee Score，HSS）评估患者术后膝关节功能康复效果，Logistics回归分析术后关节功能康复效果的影响因素，建立Logistic回归预测模型，进一步评估该模型预测术后关节功能康复效果的敏感度和特异度。 结果 胫骨平台伴髁间棘骨折患者328例，术后膝关节功能恢复良好82.93%，术后膝关节功能恢复不良17.07%；Logistic回归方程分析得知，年龄、体重指数、术前（American Society of Anesthesiologists，ASA）分级、手术时间、骨质疏松、术前膝关节活动度、术后疼痛是胫骨平台伴髁间棘骨折患者术后关节功能康复效果的影响因素（P＜0.05）；当Logistic（P）＞3.87时预测价值最优，敏感度为67.9%，特异度为93.5%。 结论 受年龄、体重指数、术前ASA分级、手术时间、骨质疏松、术前膝关节活动度、术后疼痛等因素影响，胫骨平台伴髁间棘骨折患者术后存在膝关节功能恢复不良风险，临床应加强预防性干预，以提高康复效果，改善预后。

Analysis of influencing factors of joint function rehabilitation after surgery for tibial plateau fracture combined with intercondylar spine fracture

Objective To analyze the factors affecting the effect of postoperative joint function rehabilitation in patients with tibial plateau fracture combined with intercondylar spine fracture by Logistic regression analysis, and to establish a risk model prediction to further lay the foundation for postoperative knee joint function rehabilitation.Methods A total of 272 patients with tibial plateau fracture combined with intercondylar spine fracture were selected as the research subjects. The Knee Joint Score of the American Hospital of Special Surgery(HSS) was used to evaluate the postoperative knee function rehabilitation effect of the patients, and logistics regression analysis was used to analyze the influencing factors of postoperative joint function rehabilitation effect. A Logistic regression prediction model was established to further evaluate the sensitivity and specificity of this model to predict postoperative joint function rehabilitation effect.Results In 272 patients with tibial plateau fracture combined with intercondylar spine fracture, the postoperative knee function recovered well in 79.41%of patients, and the postoperative knee function recovered poorly in 20.59% of patients. The logistic regression analysis showed that age, body mass index(BMI), preoperative American Society of Anesthesiologists(ASA) grade, and duration of operation, osteoporosis, preoperative range of motion(ROM) of the knee joint, and postoperative pain were the influencing factors of postoperative joint function rehabilitation in patients with tibial plateau fracture combined with intercondylar spine fracture(P＜0.05). When Logistic(P) was >3.87, the predictive value was the highest, with a sensitivity of 67.9% and a specificity of 93.5%.Conclusion Affected by factors such as age, BMI, preoperative ASA grade, duration of operation, osteoporosis, preoperative ROM of the knee joint, and postoperative pain, patients with tibial plateau fracture combined within tercondylar spine fracture are at risk of poor recovery of knee joint function after surgery. In clinical practice,preventive interventions should be strengthened to improve the rehabilitation effect and prognosis.