中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (27): 7135-7141.doi: 10.12307/2026.445

• 骨科植入物Orthopedic implants • 上一篇    下一篇

股骨远端骨折松解术中活动度与术后膝关节功能的关系：多因素预测模型验证

董瑞波，唐东鸣，费奉龙，陈封明，汤永南   

  1. 广州市中西医结合医院下肢骨科，广东省广州市   510800
  • 收稿日期:2025-10-29 接受日期:2026-01-22 出版日期:2026-09-28 发布日期:2026-05-22
  • 通讯作者: 董瑞波，硕士，主治中医师，广州市中西医结合医院下肢骨科，广东省广州市 510800
  • 作者简介:董瑞波，男，1985年生，广东省广州市人，汉族，广州中医药大学毕业，硕士，主治中医师，主要从事创伤骨科、关节骨科、中医药治疗骨病方面的研究。

Relationship between range of motion during distal femoral fracture release surgery and postoperative knee joint function: validation of a multivariate prediction model

Dong Ruibo, Tang Dongming, Fei Fenglong, Chen Fengming, Tang Yongnan   

  1. Department of Lower Limb Orthopedics, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou 510800, Guangdong Province, China
  • Received:2025-10-29 Accepted:2026-01-22 Online:2026-09-28 Published:2026-05-22
  • Contact: Dong Ruibo, MS, Attending physician, Department of Lower Limb Orthopedics, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou 510800, Guangdong Province, China
  • About author:Dong Ruibo, MS, Attending physician, Department of Lower Limb Orthopedics, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou 510800, Guangdong Province, China

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摘要：

文题释义：

股骨骨折：指发生于股骨下段距膝关节面15 cm范围内的骨折，包括髁上及髁间骨折，多由高能量创伤或老年骨质疏松引发，常合并膝关节功能障碍。
镜下关节松解术：在关节镜辅助下，通过微创入路松解膝关节内粘连组织及挛缩结构，以恢复关节活动范围的术式，具有创伤小、恢复快的优势。

摘要
背景：股骨远端骨折术后膝关节僵硬是患者功能恢复的核心问题，其病理机制涉及伸膝装置粘连、关节囊挛缩、关节面形态异常等因素。  
目的：探讨关节镜联合小切口粘连松解治疗股骨远端骨折术后伸直性膝关节僵硬的疗效，并分析影响膝关节功能恢复的危险因素。
方法：选择2019年3月至2024年10月广州市中西医结合医院收治的股骨远端骨折术后非感染性伸直性膝关节僵硬患者152例，根据松解术后6个月美国特种外科医院膝关节评分分为恢复良好组(≥70分，n=122)和恢复较差组(< 70分，n=30)。收集患者年龄、复位质量、连续被动运动功能锻炼等临床资料，采用单因素及多因素Logistic回归分析法筛选危险因素，建立预测模型并通过受试者工作特征曲线、校准曲线和决策曲线评估模型效能。
结果与结论：①单因素分析显示年龄≥60岁、非解剖复位、无连续被动运动锻炼、术后并发症、术中屈伸活动度< 120°、术前胫骨内侧关节线改变程度增大及术前美国特种外科医院膝关节评分降低与术后功能恢复较差显著相关(均P < 0.05)；②多因素分析确认年龄≥60岁、无连续被动运动锻炼、术后并发症、术中活动度< 120°、术前美国特种外科医院膝关节评分低及胫骨内侧关节线改变大为独立危险因素(均P < 0.05)；③阈值效应分析揭示术中活动度与恢复风险呈非线性关系(P < 0.001)，120°为拐点，活动度< 120°时，每增加1°恢复风险降低3.3%(OR=0.967)；≥120°时风险不再显著降低(P=0.073)；④预测模型的区分度(曲线下面积=0.821，95%CI：0.760-0.953)、校准度(Brier值=0.097)及临床净收益(决策曲线阈值0.1-0.9)均表现良好。提示：股骨远端骨折术后膝关节僵硬患者功能恢复与术中活动度阈值(120°)、年龄、康复管理及术前关节状态密切相关，基于6项独立危险因素构建的预测模型具有良好效能，可为临床干预提供依据。



中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: ">股骨骨折, 膝关节僵硬, 松解术, 膝关节功能, 预后, 预测模型

Abstract: BACKGROUND: Postoperative knee joint stiffness after distal femoral fracture is a core problem affecting functional recovery of patients. Its pathological mechanisms involve factors such as extensor mechanism adhesion, joint capsule contracture, and abnormal articular surface morphology. 
OBJECTIVE: To explore the efficacy of arthroscopy combined with small incision adhesion release in the treatment of extension stiff knee after distal femoral fracture, and to analyze the risk factors affecting the functional recovery of knee joint. 
METHODS: One hundred and fifty-two patients with non-infectious extension stiff knee after distal femoral fracture were selected in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2019 to October 2024. Patients were divided into good recovery group (≥70, n=122) and poor recovery group (< 70, n=30) according to Hospital for Special Surgery score 6 months after operation. The clinical data including patient age, reduction quality and continuous passive motion exercise were collected. The risk factors were analyzed by univariate and multivariate Logistic regression. A prediction model was established and the effectiveness of the model was evaluated by receiver operating characteristic curve, calibration curve, and decision curve. 
RESULTS AND CONCLUSION: (1) Univariate analysis showed that age ≥60 years old, non-anatomical reduction, no continuous passive motion exercise, postoperative complications, intraoperative flexion and extension range < 120°, increased preoperative changes of medial tibial joint line and decreased preoperative Hospital for Special Surgery score were significantly related to poor postoperative functional recovery (all P < 0.05). (2) Multivariate analysis confirmed that age ≥60 years, no continuous passive motion exercise, postoperative complications, intraoperative range of motion < 120°, low preoperative Hospital for Special Surgery score, and large change of medial tibial joint line were independent risk factors (all P < 0.05). (3) Threshold effect analysis revealed that there was a nonlinear relationship between intraoperative range of motion and recovery risk (P < 0.001), with 120° as the inflection point. When the activity was less than 120°, the recovery risk decreased by 3.3% for each increase (OR= 0.967). When ≥ 120°, the risk was no longer significantly reduced (P=0.073). (4) The discrimination (area under the curve = 0.821, 95% CI: 0.760–0.953), calibration (Brier value =0.097), and clinical net benefit (decision curve threshold 0.1–0.9) of the prediction model were all good. (5) These findings suggest that the functional recovery of stiff knee patients after distal femoral fracture is closely related to the threshold of intraoperative activity (120°), age, rehabilitation management, and preoperative joint state. The prediction model based on six independent risk factors has good efficacy and can provide basis for clinical intervention.

Key words: femoral fracture, knee joint stiffness, release surgery, knee joint function, prognosis, prediction model

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