| Objective:The study was a retrospective analysis of clinical follow-up data that using the condylar buttress plate(CBP) surgical treatment of distal femoral fractures. In order to explore the related factors that affect their surgery. The purpose of this study was to improve the CBP treatment of distal femoral fractures in patients with surgical treatment for providing valuable clinical reference.Methods:This study retrospectively analyzed the42cases with43side of distal femoral fractures that was treated by CBP surgical treatment in the period from August2004to August2011in the Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical College. The study involved29males and13females, with the average age32.5. And26cases on the left side, right side in17cases, including one bilateral cases. Cause of injury:29cases of traffic injury,6cases of fall injury, fell seven cases, and other injuries. There were five type-Al, five type-A2, eight type-A3, four type-C1, nine type-C2and twelve type-C3fractures according to the AO/ASIF system;19cases were open fractures,23cases were closed fractures, and one closed fractures patients had bilateral fractures; Multiple injuries in17cases, of which11cases of craniocerebral trauma, six cases with chest and abdominal organ injury. In this study, the CBP treatment of distal femoral fractures influencing factors are grouped as follows:(1) Gender of all patients were segmented into a male group and female group;(2) Age<45years old is set to the youth group,45to59-year-old is set to middle-aged group,≥60years is set to old age group;(3)Fracture type of all patients were segmented into Type A and Type C two groups according to the AO/ASIF classification of distal femoral fractures;(4) According to the fracture category of all patients were segmented into the open fracture group and the closed fracture group;(5) According to whether the merger with multiple injuries was divided into a single injury group and multiple injuries group;(6) The opportunity of surgery was set to<7days group and>7days group;(7)The quality of reduction was set to the satisfaction group and dissatisfaction group.(8) Whether the bone graft of all patients were segmented into the bone graft group and the bone graft group;(9) Gypsum immobilization of all patients were segmented into without gypsum immobilization group and gypsum immobilization group;(10) CPM exercise of all patients were segmented into CPM exercise group and non-CPM exercise group;(11) The operative outcomes was according to Neer knee functional score sheet. When we used the statistical analysis, the results were divided into two group:score>72is divided into excellent group,<72is divided into non-excellent group. The operative outcomes which might been affected by the possible relevant factors, such as age, gender, fracture type, fracture classification, type of injury, opportunity of surgery, the quality of reduction, bone graft, gypsum brake and CPM exercise, were used as univariate analysis. Univariate analysis were processed with X2test and there were the statistically significant which were showed by p<0.05. Put the statistically significant factors into the Logistic regression analysis, to investigate the independent risk and protective factors for CBP treatment of distal femoral fractures.Results:(1) Gender:there was not statistical difference between male group and female group(p>0.05);(2)Age:there was statistical difference between youth group, middle-aged group and the old age group(p<0.05);(3) Fracture type:there was statistical difference between A-type group and C-type group(p<0.05);(4) Fracture category:there was not statistical difference between the open fracture group and the closed fracture group (p>0.05);(5)Type of injury:there was statistical difference between single injury group and multiple injuries group(p<0.05);(6) The opportunity of surgery:there was statistical difference between<7days group and>7days group(p<0.05);(7) The quality of reduction:there was statistical difference between satisfaction group and dissatisfaction group(p<0.05);(8) The bone graft:there was not statistical difference between the open fracture group and the closed fracture group (p>0.05);(9) Gypsum immobilization:there was statistical difference between without gypsum immobilization group and gypsum immobilization group(p<0.05);(10) CPM exercise:there was statistical difference between CPM exercise group and non-CPM exercise group(p<0.05). Univariate analysis manifestated that age, fracture type, type of injury, the opportunity of surgery, the quality of reduction, gypsum immobilization and CPM exercise were closely correlated with the prognosis of surgical treatment with femoral condylar buttress plate for distal femoral fractures with a significant difference (p<0.05). The Logistic regression analysis showed that age (OR=13.724), the type of fracture (OR=59.629), the quality of reduction (OR=12.848) were independent risk factor for the operative outcomes, the CPM exercise (OR=0.117) were independent, protective factors for the operative outcomes.Conclusion:It showed that Age, fracture type, quality of reduction were independent risk factors of the operative outcomes by surgical treatment with CBP for distal femoral fractures; And CPM exercise was the independent protective factor to the operative outcomes by surgical treatment with CBP for distal femoral fractures.(1) satisfactory reduction, solid and effective internal fixation are the most important factors to achieve good operative outcomes;(2) for elderly patients, especially patients with osteoporosis, in order to improve the operative outcomes, anti-osteoporosis treatment is also very important;(3) Removal of gypsum immobilization as soon as possible, and began CPM exercise could effectively prevent complications and improve operative outcomes. |
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