髋臼后壁骨折临床疗效的相关因素分析

目的通过归纳患者的临床病历，总结影响髋臼后壁骨折（PWFA）手术效果的相关危险因素，为PWFA的诊治及不良反应预后提供临床参考依据。方法选择金华文荣医院2009年4月—2012年4月收治的82例髋臼后壁骨折患者，对其采用手术切开复位内固定的方法进行治疗，复位满意后采取重建钢板进行内固定。根据Matta评分确定术后疗效，并对可能与之相关的因素进行单因素分析，筛选出具有统计学意义的因素之后，再采用多因素Logistic回归分析，确定影响疗效的独立危险因素。结果经过治疗，82例患者当中，Matta评分优为34例，占41．5％，良16例，占19．5％，可22例，占26．7％，差10例，占12．3％。患者髋臼后壁骨折临床优良率为61．O％，单因素分析显示，年龄〉45岁、受伤后到手术的时间〉2周、复位不满意、合并髋关节脱位、合并其他伤、骨折粉碎程度〉2块均为影响PWFA术后效果的相关因素。Logistic多因素回归分析显示，伤后至手术的时间（P=0．001，OR=1．057），骨折粉碎程度（P=0．026，OR=1．766），复位质量（P=0．033，OR=1．938）是影响髋臼后壁骨折的独立危险因素。结论通过分析影响PWFA手术效果的危险因素，得出伤后至手术时间、骨折粉碎程度及复位质量是影响手术效果的独立危险因素，因此，选择合适的时机尽早手术，复位精准及牢固的内固定，可显著提高临床优良率，减少术后并发症的发生。

Related factors analysis of clinical effect of posterior wall fractures of the acetabulum

Objective To exolore the related factors of clinical curative effect of posterior wall fractures of the acetabulum （PWFA） by summarying of clinical data of patients and provide the reference for the clinical treatment. Methods 82 cases of PWFA were chose and analyzed retrospectively from 2009.4--2012.4. All patients were treated with open reduction and internal fixation operation. Efficacy was evaluated by Matta scores. Logistic regression and Single factor analysis were used to analyze the risk factors. Results After treatment, Matta score of 82 patients were observed. There were 34 cases in excellent, accounting for 41.5 % , 16 cases in good, accounting for 19.5 % ,22 cases in general, accounting for 26.7 % , and 10 cases in poor, accounting for 12.3%. The excellent-and-good rate of PWFA was 61.0%. Single factor analysis showed that, age 〉 45 years, injury to operation time 〉 2 weeks, unsatisfactory reduction, complicated with dislocation of hip joint and other injuries and high degree of fracture comminution were influencing factors of the results. Multivariate Logistic regression analysis showed the time from injury to operation（ P = 0. 001, OR = 1. 057 ）, eomminution degree（ P = 0. 026, OR = 1. 766, The quality of reduction（ P = 0. 033, OR = 1. 938 ） were independent risk factors for acetabulum pos- terior wall fractures. Conclusion The time from injury to operation, comminution degree and the quality of reduction were independent risk factors which influencing the operation effect.