Logistic Analysis Of The Surgical Treatment Of Comminuted Adult Femoral Shaft Fractures

Background:Femoral shaft fractures is one of the most common fractures in Adult, about6%of all. Among them, the comminuted fracture is mostly due to the high-energy injury in which situation blood supply has been severely damaged, and reset in surgery is difficult to achieve anatomic reduction or satisfactory biomechanical stabi lity. In recent years, the treatment of comminuted fractures of the femoral shaft has achieved great progress thanks to the continuous development of biological materials, fixation devices and surgical technology. However, delayed union, nonunion and limb shortening deformity, angular deformities and other serious complications are very common in clinical. How to reduce and avoid these serious complications has become the focus and difficulty which the clinical research faced. Though there are many reports about the efficacy of the femoral shaft comminuted fracture before. Some views is not so complete among them, sample size is not enough, mutual interference between the various factors, research design and methods is not very scientific, all above will inevitably lead to poor statistical significance. Objecti ve:The aim of this article is to find out the related factors affecting the surgical treatment in femoral shaft comminuted fracture By complete regression analysis and scientific statistical methods. and then, to establish effective measures to improve the excellent rate of treatment.Materials end Methods:The clinical information of132patients was gathered in Hubei Provincial Hospital of TCM from December2005to February2009.97cases of male,35cases of female, all cases age from19to63years old(average40.6years). Comminuted femoral shaft fractures are classified by the Winquist and Hansen system:49cases of Grade Ⅰ fractures,39cases of Grade Ⅱ fractures,36cases of Grade Ⅲ fractures,8cases of Grade Ⅳ fractures. The patients who had adjacent joint trauma:4cases combining proximal femoral fractures,6cases combining pelvic fracture,24cases combining trauma around knee (contain ligament and menisci), a total of34cases. There are two options in fixation material:56cases were treated by locking compression plate,76by Interlocking intramedullary nail.42cases in which the nail in the treatment group to select closed nailing, the remaining90cases are after implantation of open reduction and internal fixation. There are48patients had been accept adjuvant treatment of Traditional Chinese Medicine(TCM), which cured in Hubei Provincial Hospital of TCM, while the other84cases which treated in Hubei General Hospital hadn’t receive similar treatment. it’s very necessary to guide the patients with a reasonable functional recovery training and review fractures healing after treatment The efficacy of fixation surgery assessed in fracture healing is commented by Kolmerl-standards.Then, we can creat the raw data table according this form. With the differences significantly sexual test standard for P<0.05, the author set8index (patients gender, and age, and fracture type, and adjacent joint trauma, and open reduction or closed reduction during the surgery, and types of internal fixation, and treatment of traditional chinese medicine; and reasonable functional recovery training) as independent variable,and clinical efficacy as dependent variable.In order to analyze more convenient, all patients has been divided into a good group and a poor group according to the above standards. Assignment to these variables with the logistic model, to find out the related factors which affect clinical efficacy by regression analysis. All data processing was done by SPSS20.0Statistieal soft ware Packages.Result:All of the patients in this study had got follow-ups. The time varied from5months to26months (average was10.6months). The efficacy of fixation surgery was assessed in fracture healing standards and Kolmerl-standards:Excellent in53cases, good in58cases, fair in17cases and poor in4cases. The whole excellency was84.1%. The results of logistic regression analysis showed fracture types, and adjacent joint trauma, and open reduction or closed reduction during the surgery, and types of internal fixation, and treatment of traditional chinese medicine; and reasonable functional recovery training is independent of the outcome of the risk factor has Statistics Significance, but gender and age. Conclutions:Such as fracture types, and adjacent joint trauma, and open reduction or closed reduction during the surgery, and types of internal fixation, and treatment of traditional Chinese medicine; and reasonable functional recovery training, they are the the risk factors affecting the surgical treatment in femoral shaft comminuted fracture. Among this, we can find that fracture types and adjacent joint trauma are established factors, whether choosing open reduction or closed reduction during the surgery, applying types of internal fixation or treatment of traditional chinese medicine; reasonable functional recovery training are controllable factors. During daily clinical work, Comprehensive analysis of the patients’condition and actively intervene modifiable risk factors are bound to improve the excellent rate of fracture treatment.