Analysis On Relative Factors Effecting The Clinical Outcome Of Surgical Treatment For Complex Fracture Of Tibial Plateau

Objective: To discuss relative factors which influence surgical treatment of complex fracture of tibial plateau and provide corresponding suggestions so as to establish the theoretic basis for a further improvement of curative effect.Methods: A total of 82 patients with complex fracture of tibial plateau which had been operated in our hospital from Jan.2000 to Jun.2008, the clinical data of them were collected for statistical analysis in order to definite the factors affecting the results of operative treatment. All the clinical parameters including age, sex, weight, cause of injury, type of fracture ,associated injury around the knee, operation time , reduction status, complications and postoperative healing were investigated as predictive risk factors in order to find the risk factors, the data was dealt with x~2 test and multivariate Logistic regression analysis (the parameters with P<0.05). All of statistic was treated with SPSS 13.0Results: The 82 patients were all followed up for 6-78 months(averaged 32.6 months).The clinical results were assessed according to Rasmussen, functional grading system for knee joint.The result of the treatment was evaluated as excellent in 40patients, good in 28, fair in 8 and poor in 6 patients.The excellent and good results was 82.9%. Univariate analysis demonstrated that many factors were significantly correlated with the curative outcome of complex fracture of tibial plateau, such as type of fracture, associated injury around the knee, operation time, reduction status, complications and postoperative healing(P<0.05). Such factors as age, sex, weight, cause of injury had no statistics significant influence the curative outcome of complex fracture of tibial plateau(P > 0.05).The multivariate Logistic regression analyses showed that type of fracture, associated injury around the knee, reduction status and postoperative healing were the significant independent predictors(P<0.05).Conclusions:1 .Type of fracture, associated injury around the knee, reduction status and postoperative healing are independent factors affecting the outcome of the operative treatment of complex fracture of tibial plateau.2.For a further improvement of curative effect, we should take effective preventional measures as follow: (1)Upon treatment of of complex fracture of tibial plateau, plain radiographs and spiral CT with 3D reconstruction in preoperation help to classify fractures in tibial plateau and precisely measure cracks and collapses, contributing to planning a rational treatment.(2) Anatomic reductoin should be done in operation as possible as we can, cample bone should be transplanted for bone defeats, suitable and rigid internal fixation should be used, cross ligaments, collateral ligaments and meniscus injury should be effectively repaired.(3)Early comprehensive rehabilitation measures in postoperation should be instruct truely, such as early active exercise, extention-flexion movement, early use of rehabilitating equipment (CPM) and herbal fumigation. These above can help to improve the functions of knee joints after operations on patients with complex fracture of tibial plateau.