Multivariate Logistic regression analysis of prognosis of posterolateral condylar fractures of tibial plateau treated with posterolateral buttress fixation

doi:10.3969/j.issn.2095-4344.1478

Abstract

Abstract:

BACKGROUND: The treatment of the posterolateral condyle fracture involving the tibial plateau has always been controversial, mainly focusing on the surgical indications of the posterolateral support fixation. It is hoped that this study can provide help for the solution of this problem.

OBJECTIVE: To study the effect of posterolateral buttress fixation on prognosis of patients with posterolateral condyle fracture of tibial plateau.

METHODS: Follow-up survey was conducted in patients with posterolateral condylar fracture of tibial plateau treated surgically in the First People’s Hospital of Lianyungang from January 2011 to December 2016. The Hospital for Special Surgery score of knee joint was used as the observational index. The imaging differences of anteroposterior diameter of posterolateral bone mass, posterolateral tibial plateau obliquity, posterolateral cortex comminution, proximal fibula fracture and medial condyle fracture were taken as mixed factors. Multivariate regression analysis was used to study the effect of posterolateral buttress fixation on the prognosis of patients.

RESULTS AND CONCLUSION: (1) The data of 200 patients were obtained with a follow-up time of 12-24 months. The Hospital for Special Surgery score of the knee joint at the last survey was from 62 to 95, mean 85.1 ± 5.8. (2) Univariate analysis showed that anteroposterior diameter of posterolateral bone mass, posterior tilt angle of lateral tibial plateau, proximal fibular fracture, medial condylar fracture, and posterolateral buttress fixation were correlated with Hospital for Special Surgery score after operation for tibial plateau fracture involving posterolateral condyle (P < 0.05). (3) Multivariate stratified analysis further confirmed that posterolateral buttress fixation could improve the Hospital for Special Surgery score of knee joint in patients with anterolateral bone mass diameter < 20 mm, proximal fibular fracture, and the posterolateral tibial plateau inclination angle ≥15° in one-year follow-up (P < 0.01). However, no significant difference was found in the Hospital for Special Surgery score and satisfaction level of the patients with posterolateral bone mass no less than 20 mm. (4) Compared with anterolateral raft plate fixation, posterolateral buttress fixation can significantly improve the Hospital for Special Surgery score of patients with anterolateral bone mass diameter less than 20 mm in one-year follow-up. It is recommended that posterolateral buttress fixation could be used for such patients. For the proximal fibula fracture and the posterolateral tibial plateau condylar fracture with the posterolateral tibial plateau inclination angle no less than 15°, the posterolateral buttress fixation can also improve the good rate one year after operation, which is recommended as a reference index.

Key words: tibial plateau fractures, posterolateral, posterior tilt, buttress fixation, Logistic model, prognosis analysis, Hospital for Special Surgery score

CLC Number:

R459.9|R687.3+2|R318

Yu Jian, Xu Gang, Sun Hong, Yin Zhaoyang, Sheng Luxin, Li Leiming, Sun Xiao, Huo Yongfeng. Multivariate Logistic regression analysis of prognosis of posterolateral condylar fractures of tibial plateau treated with posterolateral buttress fixation[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(32): 5138-5145.

Figures/Tables 5

2.5 影响术后1年随访膝关节HSS评分的多因素分析见表4。单因素分析随访膝关节HSS评分的影响因素(未校正)，校正患者年龄和性别和表3所有因素的多元回归中，结果一致表明后外侧支撑固定是提高术后1年随访膝关节HSS评分的独立影响因素，在校正了多种因素模型中，后外侧支撑可以提高术后1年随访膝关节HSS评分3.7分(95%CI：2.3，5.1)。结果还提示提示合并腓骨近端骨折、后外侧骨块前后径<20 mm、胫骨外侧平台后倾角≥15°、合并内侧髁骨折均是HSS评分不良的独立影响因素(P < 0.05)。 2.6 后外侧支撑固定对HSS评分及满意度的影响因素分层分析进一步分层分析后外侧支撑固定对膝关节HSS评分的影响因素发现，与后外侧支撑有交互作用的唯一相关因素是后外侧骨块前后径。表4展示了在校正了年龄和性别以及是否合并腓骨近端骨折、后外侧骨块后倾角大小、是否合并内侧髁骨折等因素的混杂作用后，后外侧支撑固定对后外侧骨块前后径<20 mm患者的术后1年随访HSS评分提高了6.1分(95%CI：4.1，8.2)，对后外侧骨块前后径≥20 mm患者的随访HSS评分提高了1.7分(95%CI：-0.1，3.6)，对这2组差异进行检验表明，后外侧支撑固定和后外侧骨块前后径大小存在显著的交互作用(P=0.001 7)。此次结果表明对后外侧骨块前后径<20 mm的患者行后外侧支撑固定收益较大。表4中其他影响HSS评分因素的结果表明，胫骨外侧平台后倾角≥15°，合并腓骨近端骨折，合并内侧髁骨折这3个危险因素与后外侧支撑固定对随访HSS评分无交互作用，不论是否具有这3项危险因素，进行后外侧支撑固定对随访膝关节HSS评分都有提高(P < 0.05)，但分层之间的差异无显著性意义。表5还采用HSS≥85分作为满意度指标进行分层多元Logistic回归，结果表明，对外侧骨块前后径<20 mm或合并内侧髁骨折的患者进行后外侧支撑固定可显著提升患者HSS评分优良率，表现出显著的交互作用(P < 0.05)。对合并腓骨近端骨折的患者进行外侧支撑固定可以显著提高满意度(P=0.000 2)，但OR值的提高与未合并腓骨近端骨折的患者差异无显著性意义(P=0.262 6)。胫骨外侧平台后倾角不论是否>15°进行外侧支撑固定均可提升HSS评分优良率，但2组OR值之间差异无显著性意义(P=0.913 8)。"

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