踝关节骨折术后踝穴形态变化与踝关节功能的相关因素分析  

Correlation analysis between the morphological changes of ankle acupoints and the ankle function after ankle fracture surgery

作　　者：刘玉波[1] 张会增[1] 张同润 睢更义 马楠[1] 程旭 高旭鹏 许敬 王朝亮 Liu Yubo;Zhang Huizeng;Zhang Tongrun;Sui Gengyi;Ma Nan;Cheng Xu;Gao Xupeng;Xu Jing;Wang Chaoliang(General Hospital of Jizhong Energy Xingtai Mining Group Co.,Ltd.,Xingtai 054000,Hebei Province,China;Xingtai Hospital of Traditional Chinese Medicine,Xingtai 054001,Hebei Province,China;Jinan People’s Hospital Affiliated to Shandong First Medical University,Jinan 250014,Shandong Province,China)

机构地区：[1]冀中能源邢台矿业集团有限责任公司总医院,河北省邢台市054000 [2]邢台市中医院,河北省邢台市054001 [3]山东第一医科大学附属济南人民医院,山东省济南市250014

出　　处：《中国组织工程研究》2022年第3期440-445,共6页Chinese Journal of Tissue Engineering Research

基　　金：河北省邢台市科技计划项目(2019ZC241),项目负责人:刘玉波。

摘　　要：背景:踝关节骨折手术后关节解剖形态的恢复,对关节的活动度和关节功能有极大的影响,以往研究仅仅关注术后踝穴高度恢复情况,因此研究骨折术后踝穴形态变化与功能变化的相关性具有重要意义。目的:探讨踝关节骨折术后踝穴形态变化与踝关节功能及踝关节活动度之间的相关性,并分析踝关节功能的预后影响因素。方法:纳入冀中能源邢台矿业集团有限责任公司总医院于2017年1月至2018年12月期间收治的268例单侧踝关节骨折患者,根据Mazur评分法对所有患者患侧踝关节功能进行评分并分组:Mazur评分优(93-100分)132例,良(87-92分)65例,可、差(<87分)71例。对比不同分组患者末次随访时患侧与健侧踝穴形态相关指标(踝穴宽度、深度、矢状位角度及冠状位角度)之间的差值差异;采用Pearson相关性分析法观察各踝穴形态变化指标与踝关节功能及踝关节活动度之间的相关性,并采用多元有序logistic回归分析影响患者踝关节功能恢复的相关独立危险因素。结果与结论:(1)与健侧比较,患者患侧踝穴宽度、深度以及冠状和矢状位角度均明显增大(P<0.001),且患者患侧背屈活动度、跖屈活动度以及背屈肌力、跖屈肌力均明显下降(P<0.001);(2)末次随访时,Mazur评分优组、良组及可、差组患者患侧和健侧的踝穴宽度、踝穴深度、冠状位角度以及矢状位角度差值之间差异有显著性意义(P<0.001);(3)Pearson相关性分析显示,患者患侧踝穴宽度、踝穴深度、冠状位角度、矢状位角度均与背屈活动度、跖屈活动度、背屈肌力、跖屈肌力呈显著负相关性(P<0.05);(4)多元有序logistic回归分析结果显示,年龄>60岁、骨折分型C型、开始康复时间>7 d、未行跟骨牵引以及踝穴形态指标(患侧和健侧踝穴宽度、踝穴深度、冠状位角度以及矢状位角度差值大)均为影响踝关节骨折患者手术后功能恢复的独立危险因BACKGROUND:The recovery of joint anatomical morphology after ankle fracture surgery has a great impact on the range of motion and joint function.Previous studies only focused on the postoperative height recovery of ankle acupoints,so it is of great significance to study the correlation between the morphological changes of ankle acupoints and the functional changes after fracture surgery.OBJECTIVE:To explore the correlation between the morphological changes of ankle acupoints,ankle joint function and ankle joint range of motion after ankle joint fracture surgery,and analyze the prognostic factors of ankle joint function.METHODS:A total of 268 patients with unilateral ankle fractures admitted to General Hospital of Jizhong Energy Xingtai Mining Group Co.,Ltd.from January 2017 to December 2018 were included in this study.According to the Mazur scoring method,the function of the affected ankle joint of all patients was scored and grouped:132 cases in the excellent group(93-100 scores),65 cases in good group(87-92 scores),and 71 cases in average and poor group(<87 scores).The difference between the morphological indicators(width,depth,sagittal angle and coronal angle of the ankle acupoint)on the affected side and the uninfected side of the patients was compared in different groups at the last follow-up.Pearson correlation was used to analyze the correlation between the morphological change indicators of ankle acupoints,ankle joint function and ankle joint range of motion.Multivariate ordered logistic regression was used to analyze the related independent risk factors affecting the recovery of the patient’s ankle joint function.RESULTS AND CONCLUSION:(1)Compared with the healthy side,the width and depth of the ankle acupoint on the affected side,as well as the coronal and sagittal angles were significantly increased(P<0.001);and the patient’s dorsiflexion range of motion,plantar flexion range of motion,dorsiflexor strength,and strength of plantar flexor muscles decreased significantly on the affected side(P<0.001).

关 键 词：踝关节骨折 踝穴 踝关节功能 踝关节活动度 预后 影像学 肌力 影响因素 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]