| 掌侧锁定接骨板治疗背侧移位桡骨远端骨折术后软组织并发症原因分析 |
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Received:November 01, 2022
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| 作者 | Author | 单位 | Unit | E-Mail |
| 邰金谷 |
TAI Jin-gu |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 丁志勇 |
DING Zhi-yong |
南京明基医院骨科中心, 江苏 南京 210019 |
Department of Orthopaedic Surgery, Nanjing Benji Hospital, Nanjing 210019, Jiangsu, China |
dzyong7622@163.com |
| 孙亮 |
SUN Liang |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 曹云平 |
CAO Yun-ping |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 叶国宝 |
YE Guo-bao |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 郝鹏 |
HAO Peng |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 李伟 |
LI Wei |
德驭医疗马鞍山总医院骨科中心, 安徽 马鞍山 243000 |
Orthopaedic Center, Deyu Medical Ma'anshan General Hospital, Ma'anshan 243000, Anhui, China |
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| 期刊信息：《中国骨伤》2023年36卷，第9期，第839-845页 |
| DOI：10.12200/j.issn.1003-0034.2023.09.009 |
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目的：探讨背侧移位桡骨远端骨折(distal radius fracture,DRF)患者行掌侧锁定接骨板手术后发生软组织并发症的原因。
方法：自2016年7月至2021年5月,采用掌侧锁定接骨板手术治疗112例背侧移位DRF患者,其中男45例,女67例;年龄18~85(46.24±10.08)岁。根据术后是否出现软组织并发症,分为并发症组(40例)和无并发症组(72例)。与术前相比,术后患者的桡骨掌倾角和尺偏角、腕关节屈曲活动度和背伸活动度、握力均显著改善(P<0.05)。与无并发症组相比,并发症组年龄>60岁、身体质量指数(body mass index,BMI) ≥ 30 kg·m-2、吸烟、糖尿病、骨折C型、开放性骨折以及手术时间 ≥ 90 min的患者比例均更高(P<0.05)。通过多因素Logistic回归分析年龄、BMI、吸烟、糖尿病、骨折AO分型、骨折类型以及手术时间,以确定影响患者术后软组织并发症发生的独立危险因素,建立列线图预测模型,并进行模型评价。
结果：末次随访,腕关节功能恢复优良率为83.93%(94/112),骨折复位优良率为84.82%(95/112)。多因素Logistic回归分析结果显示,年龄>60岁、糖尿病、骨折C型、开放性骨折以及手术时间 ≥ 90 min,均为患者术后软组织并发症发生的独立危险因素(P<0.05)。列线图预测模型的受试者工作特征曲线(receiver operating characteristic,ROC)、校准曲线和临床决策曲线显示其区分度、准确性和有效性均较好。
结论：年龄>60岁、糖尿病、骨折C型、开放性骨折以及手术时间 ≥ 90 min,均为DRF掌侧钢板固定术后软组织并发症发生的独立危险因素。在临床治疗中,对该类患者应做好围手术期软组织管理,预防并发症的发生。 |
| [关键词]:桡骨远端骨折 锁定接骨板 软组织并发症 危险因素 |
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| Analysis of the causes of soft tissue complications after volar locking plate for the treatment of dorsal displaced distal radius fractures |
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Abstract:
Objective To investigate the causes of soft tissue complications in patients with dorsal displacement distal radius fractures (DRF) after volar locking plate surgery.
Methods From July 2016 to May 2021,112 patients with dorsal displacement DRF were treated with volar locking plate surgery,including 45 males and 67 females. The average age was (46.24±10.08) years old,ranging from 18 to 85 years old. According to whether there were soft tissue complications after operation,they were divided into complication group (40 cases) and non complication group (72 cases). Compared with preoperation,the radial metacarpal inclination and ulnar deflection angle,wrist flexion activity and dorsal extension activity,and grip strength of patients after operation were significantly improved (P<0.05). Compared with the non complication group,the proportion of patients in the complication group whose age was>60 years,body mass index (BMI) more than 30 kg·m-2,smoking,diabetes,fracture type C,open fracture and operation time more than 90 min was higher (P<0.05). The age,BMI,smoking,diabetes,fracture AO classification,fracture type and operation time were analyzed by multifactor Logistic regression to determine the independent risk factors affecting the occurrence of postoperative soft tissue complications of patients,establish a nomogram prediction model,and evaluate the model.
Results At the latest follow-up,the excellent and good rate of wrist joint function recovery was 83.93% (94/112),and the excellent and good rate of fracture reduction was 84.82% (95/112). Multivariate Logistic regression analysis showed that age more than 60 years old,diabetes,fracture type C,open fracture and operation time more than 90 min were independent risk factors for postoperative soft tissue complications (P<0.05). The receiver operating characteristic (ROC),calibration curve and clinical decision curve of the nomogram prediction model showed discrimination, accuracy and validity were good.
Conclusion Age more than 60 years,diabetes mellitus,fracture type C,open fracture,and operation time more than 90 min are all independent risk factors for soft tissue complications after DRF volar plate fixation. In clinical treatment,perioperative soft tissue management should be done in such patients to prevent complications. |
| KEYWORDS:Distal radius fracture Locking plate Soft tissue complications Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 邰金谷,丁志勇,孙亮,曹云平,叶国宝,郝鹏,李伟.掌侧锁定接骨板治疗背侧移位桡骨远端骨折术后软组织并发症原因分析[J].中国骨伤,2023,36(9):839~845 |
| 英文格式: | TAI Jin-gu,DING Zhi-yong,SUN Liang,CAO Yun-ping,YE Guo-bao,HAO Peng,LI Wei.Analysis of the causes of soft tissue complications after volar locking plate for the treatment of dorsal displaced distal radius fractures[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(9):839~845 |
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