骨密度与胫骨平台骨折ORIF术后患者临床结局的关系

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摘要目的探讨骨密度与胫骨平台骨折切开复位内固定(open reduction internal fixation，ORIF)术后患者临床结局的关系。方法回顾性选择2012年1月至2016年12月来我院接受ORIF术治疗的胫骨平台骨折患者100例，根据术后1年美国特种外科医院(the hospital special surgery，HSS)膝关节功能评分将入组患者分为HSS评分大于等于70分组(72例)和HSS评分小于70分组(28例)。收集所有入组患者的治疗及随访资料，包括性别、年龄、身体质量指数(body mass index，BMI)、吸烟史、嗜酒史、糖尿病史、高血压病史、高血脂病史、初始平台塌陷程度、术后并发症发生情况、术后复位情况等，比较两组患者在临床特征方面的差异。应用单因素、多因素非条件Logistic回归分析影响胫骨平台ORIF术后患者临床结局的危险性因素。结果两组患者在年龄、糖尿病史、Schatzker分型、初始平台塌陷程度、术后并发症、术后复位、骨密度T值方面比较差异有统计学意义(P＜0.05)，在性别、BMI、吸烟史、嗜酒史、高血压病史、高血脂病史、损伤原因方面比较差异无统计学意义(P＞0.05)。单因素Logistic回归分析结果显示，年龄、糖尿病史、Schatzker分型、初始平台塌陷程度、术后并发症发生情况、术后复位情况、骨密度T值是影响胫骨平台ORIF术后患者临床结局的危险性因素(P＜0.05)。将以上变量进行多因素Logistic回归分析结果显示，年龄大于等于60岁、有糖尿病史、Schatzker分型为Ⅳ~Ⅵ型、骨密度T值小于等于－1.0不利于胫骨平台ORIF术后患者临床结局(P＜0.05)。结论骨密度与胫骨平台骨折ORIF术后患者临床结局密切相关，骨密度T值小于等于－1.0不利于胫骨平台ORIF术后患者临床结局。

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关键词 ：骨密度, 胫骨平台骨折, 切开复位内固定术, 临床结局

Abstract：Objective To investigate the relationship between bone mineral density and clinical outcomes of open reduction and internal fixation(ORIF) in patients with tibial plateau fractures.Methods Open reduction and internal fixation(ORIF) in 100 patients with tibial plateau fractures in our hospital from Jan 2012 to Dec 2016 were selected as study subjects.According to the score of 1 years postoperative knee function(HSS)，patients were divided into HSS≥70 scores group(n＝72) and HSS＜70 score group(n＝28).Data of treatment and follow-up were collected for all enrolled patients，including gender，age，body mass index(BMI)，smoking history，drinking history，history of diabetes，hypertension，hyperlipidemia，initial platform collapse depth，postoperative complications，postoperative reduction etc.The differences in clinical characteristics between the two groups were compared.Univariate and multivariate unconditional Logistic regression analysis were used to analyze the risk factors of clinical outcomes in patients with ORIF after tibial plateau surgery.Results There were significant differences between the two groups in age，history of diabetes，Schatzker classification，initial platform collapse depth，postoperative complications，postoperative reduction and bone mineral density T(P＜0.05)，there were no significant differences in gender，BMI，history of smoking，history of alcohol abuse，history of hypertension，number of cases with hyperlipidemia，and cause of injury(P＞0.05).Single factor Logistic regression analysis showed that age，history of diabetes，Schatzker type，initial platform collapse depth，postoperative complications，postoperative reduction，bone mineral density T value were the risk factor affecting the clinical outcome of patients with tibial plateau after ORIF(P＜0.05).The above variables for multivariate Logistic regression analysis showed that age≥60 years old，had a history of diabetes，Schatzker type Ⅳ~Ⅵ，bone mineral density T value≤－1.0 were not conducive to the clinical outcome of tibial plateau ORIF patients(P＜0.05).Conclusion Bone mineral density is closely related to clinical outcomes in patients with tibial plateau fractures after ORIF surgery，bone mineral density T value≤－1.0 is not conducive to the clinical outcome of postoperative patients with tibial plateau ORIF.

Key words： bone mineral density fracture of tibial plateau open reduction and internal fixation clinical outcome

通讯作者: 李宏波

作者简介: 旦锋(1981－ )，男，主治医师，汉中市中心医院骨关节创伤科，723000。

引用本文:

旦锋，谢鹏，阮文辉，余国勇，陈志惠，李宏波 *. 骨密度与胫骨平台骨折ORIF术后患者临床结局的关系[J]. 实用骨科杂志, 2018, 24(4): 314-317.
Dan Feng，Xie Peng，Ruan Wenhui，et al. Relationship Between Bone Mineral Density and Clinical Outcomes of Open Reduction and Internal Fixation(ORIF) in Patients with Tibial Plateau Fractures. sygkzz, 2018, 24(4): 314-317.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I4/314

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