Multiple stepwise regression analysis on postoperative knee joint function limitation in complex femoral condyles fractures

doi:10.3969/j.issn.2095-4344.2013.52.015

Abstract

Abstract:

BACKGROUND: Knee joint function limitation often occurs after internal fixation of complex femoral condyle fractures, but the mechanism and its influencing factors are also unclear.
OBJECTIVE: To screen and analyze the relevant factors of knee joint function limitation after internal fixation of complex femoral condyle fractures.
METHODS: We retrospectively summarized postoperative follow-up data of 6 and 12 months from 121 patients with complex femoral condyle fractures. Knee joint function recovery was evaluated according to Merchan criteria. A multiple stepwise regression analysis was carried out in terms of gender, age, causes, concomitant injuries, skin and soft tissue injury, fracture type, fixed method, operation time, postoperative plaster fixed situation, healing of postoperative incision, bone healing and postoperative functional exercises, to summarize the relevant influencing factors for knee joint function limitation.
RESULTS AND CONCLUSION: Whether the knee joint function after internal fixation was limited acted as the dependent variable Y, and factors with statistical significance of the single factor analysis served as the independent variable X. We used the multiple stepwise regression analysis for multiple factors analysis. Results showed that the gender of patients (X1), with or without concomitant injuries (X3), soft tissue damage (X4) and operation time (X6), a total of four factors, could not be introduced into the model, suggesting that these four factors had no significant correlation with postoperative knee joint function limitation. Another eight factors could be introduced into the factor analysis model, showing that the cause of injury (X2), fracture type (X5), the choice of internal fixation (X7), with or without bone graft (X8), with or without postoperative plaster cast (X9), postoperative knee joint functional exercise or not (X10) and postoperative wound healing (X11), the degree of postoperative bone healing (X12) are closely related to postoperative knee joint function limitation in complex femoral condyles fractures.

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

全文链接：

Key words: femur, fractures, knee joint, internal fixators, fracture fixation, intramedullary, regression analysis

CLC Number:

R318

Li Song-jun, Wang Zhao-jie, Tan Wei-yuan, Kuang Li-peng, Chen Jun-ping. Multiple stepwise regression analysis on postoperative knee joint function limitation in complex femoral condyles fractures[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(52): 9029-9034.

Figures/Tables 4

References

[1] 杨海峰,黄俊伍,张春林,等.不同内固定物治疗胫骨平台后内侧骨折的生物力学分析[J].中国组织工程研究,2013,17(26):4826- 4832.

[2] 郭斌,靳方运,陈成礼,等.内外组合式固定治疗股骨髁部复杂骨折[J].中国骨伤,2003,9(25):564-565.

[3] 沈文东,范为民.股骨髁部不稳定骨折四种内固定方法的生物力学[J].南京医科大学学报,2005,25(11):789.

[4] Merchan EC, Maestu PR,Blanco RP. Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system．J Trauma.1992;32(2):174-178.

[5] 王明鑫,熊敏,刘德昌,等.光辅助X射线体表定位在骨科植入物内固定中的应用[J].中国组织工程研究,2013,17(13): 2375-2382.

[6] Heiney JP, Battula S, O'Connor JA, et al. Distal femoral fixation: a biomechanical comparison of retrograde nail, retrograde intramedullary nail, and prototype locking retrograde nail. Clin Biomech (Bristol, Avon). 2012;27(7): 692-696.

[7] 盛朝辉,刘汉娇,庞瑞明,等.AO解剖钢板内固定治疗股骨髁间骨折疗效分析[J].中国骨与关节损伤杂志,2007,22(1):55-56.

[8] 江振华,赵卫东,樊仕才,等.改良“叉”形钢板固定股骨髁部C1型骨折的生物力学评价[J].中国临床解剖学杂志,2003,21(5): 498-500.

[9] 张洪涛,刘康,陈尔东,等.锁定钢板治疗股骨远端C型骨折129 例[J].实用医学杂志,2010,26(15):2764-2766.

[10] 张轩轩,隆腾飞,张丕军,等.交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的Meta分析[J].中国组织工程研究,2013,17(22): 4107-4114.

[11] 黄智,云维,邹重文,等.股骨髁部骨折的手术治疗[J].中华创伤骨科杂志,2009,11(7):640-641.

[12] 陈海涛. 股骨逆行交锁髓内钉植入固定治疗股骨髁部复杂骨折[J].右江民族医学院学报,2002,24(3):367-367.

[13] Sen RK, Gul A, Aggarwal S, et al. Comminuted refracture of the distal femur and condyles in patients with an intramedullary nail: a report of 5 cases. J Orthop Surg (Hong Kong). 2005;13(3):290-295.

[14] Kim YS, Choi HH, Cho YN, et al. Numerical Investigations of Interactions between the Knee-Thigh-Hip Complex with Vehicle Interior Structures. Stapp Car Crash J. 2005;49: 85-115.

[15] Henriksen M, Hunter DJ, Dam EB, et al. Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial. Osteoarthritis Cartilage. 2013.

[16] Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma. 2007;63(5): 1043-1053.

[17] 钟贵彬,侯春林,张伟,等.微创内固定系统治疗骨折失误原因分析及对策(附3例报告) [J].中国骨与关节损伤杂志,2007,22(2): 164-165.

[18] 包国玉,郝廷,王兴国,等.双钢板内固定治疗股骨髁间C型骨折的临床疗效分析[J].中国医药导报,2011,8(24):39-41.

[19] 姚永成,王友华,张正洲,等.内外侧双侧钢板内固定治疗复杂股骨髁间骨折[J].中国骨与关节损伤杂志,2010,25(1):51-52.

[20] Heiney JP, Barnett MD, Vrabec GA, et al. Distal femoral fixation: a biomechanical comparison of trigen retrograde intramedullary (i.m.) nail, dynamic condylar screw (DCS), and locking compression plate (LCP) condylar plate. J Trauma. 2009;66(2):443-449.

[21] 徐萃香,刘一,李长胜.当前骨折内固定治疗中的几个基本问题[J].中华骨科杂志,1996,16(4):204-207.

[22] Piscitelli P, Iolascon G, Innocenti M, et al. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty. Clin Cases Miner Bone Metab. 2013; 10(2):97-110.

[23] Pei Y, Kim Y, Obinata G, et al. Robot-aided motion planning for knee joint rehabilitation with two robot-manipulators. Conf Proc IEEE Eng Med Biol Soc. 2013;2013:2495-2498.

[24] Bretin P, O'Loughlin PF, Suero EM, et al. Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures. Arch Orthop Trauma Surg. 2011;131(8): 1115- 1120.

[25] Chang CY, Rupp JD, Reed MP, et al. Predicting the effects of muscle activation on knee, thigh, and hip injuries in frontal crashes using a finite-element model with muscle forces from subject testing and musculoskeletal modeling. Stapp Car Crash J. 2009;53:291-328.