股骨髁间骨折术后膝关节功能恢复的影响因素

背景：股骨髁间骨折内固定术后常出现膝关节功能受限,但对其功能受限的发生机制及影响因素尚无定论。目的：探究股骨髁间骨折术后膝关节功能恢复的影响因素。方法：选取2009年2月至2014年2月我院收治的股骨髁间骨折患者118例,均行切开复位内固定治疗,术后进行随访。记录并分析患者的年龄、性别、骨折原因、骨折类型、手术时机、ISS评分、固定方式、复位效果、关节囊修复、骨愈合情况和是否进行CPM功能锻炼等。结果：单因素分析显示,骨折类型为C2和C3、创伤严重评分高（ISS评分〉16分）、非解剖复位、关节囊未修复、骨愈合情况为愈合延迟和不愈合、不进行CPM功能锻炼的患者股骨髁间骨折术后膝关节功能恢复较差,有统计学差异（P〈0.05）;多因素分析显示,骨折类型为C2和C3、ISS评分〉16分、非解剖复位、关节囊未修复、骨愈合情况为愈合延迟和不愈合、不进行CPM功能锻炼是患者术后膝关节功能恢复的危险因素（P〈0.05）。结论：膝关节骨折越粉碎,合并损伤越重,预后越差。膝关节坚强固定、解剖复位、膝关节囊修复、术后早期被动及主动进行功能锻炼有利于股骨髁间骨折术后膝关节功能恢复。

Influencing factors of functional recovery of knee joint after surgery in patients with femoral intercondylar fracture

Background： Knee joint function limitation often occurs after internal fixation for femoral intercondylar fracture, but the mechanism of functional limitation and factors affecting the recovery of knee joint function are unclear.Objective： To explore the influencing factors of functional recovery of knee joint after femoral intercondylar fracture.Methods： A total of 118 patients with intercondylar fracture of femur were treated by open reduction and internal fixation between February 2009 and February 2014 in our hospital. Their age, gender, fracture reason, classification of fracture, operation time, ISS score, fixed mode, reduction, capsular repair, bone healing, CPM exercise were recorded during follow up.Results： Single factor analysis showed that patients with C2 and C3 types of fracture, high ISS score（〉16）, no anatomic reduction, no capsular repair, delayed healing and disunion and no CPM exercise had worse functional recovery of knee joint after surgery（P〈0.005）. Multiple factor analysis showed that C2 and C3 types of fracture, high ISS score（16）, no anatomic reduction, no capsular repair, delayed healing and disunion, no CPM exercise were risk factors of functional recovery of knee joint after surgery（P〈0.05）.Conclusions： The more severe crushing injury and the heavier of combined injury, the prognosis is poorer. It is advantageous to functional recovery of knee joint after femoral intercondylar fracture if patients have rigid fixation of knee joint,good anatomic reduction and capsular repair, and doing functional exercise passively or actively early after operation.