踝关节骨折术后踝穴冠状位角度波动与关节功能恢复的关系  

Relationship between coronal angle fluctuation of ankle point and recovery of joint function after ankle fracture

作　　者：刘琰 王铠[1] 吴敏[1] Liu Yan;Wang Kai;Wu Min(Department of Orthopedics,Taizhou Hospital of TCM,Taizhou 225300,Jiangsu Province,China)

机构地区：[1]泰州市中医院骨科,江苏省泰州市225300

出　　处：《中国组织工程研究》2025年第9期1820-1826,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:踝关节骨折术后的踝穴形态指标会出现相应变化,而其中踝穴冠状位角度变化与踝关节的功能恢复之间存在一定的关联,既往研究大多探讨患者术后踝穴高度恢复,故研究踝关节骨折术后踝穴冠状位角度的波动与关节功能恢复的相关性具有一定参考意义。目的:探讨踝关节骨折术后踝穴冠状位角度变化对关节功能恢复的影响。方法:纳入进行手术治疗的86例踝关节骨折患者为研究对象,根据末次随访美国骨科足踝外科协会踝-后足评分结果分为优良组(n=45)和可差组(n=41),比较两组患者的一般资料。根据踝关节的踝穴位及侧位X射线片对比术后患者患侧和健侧的踝穴形态指标:包括踝穴宽度和深度、冠状位角度及矢状位角度,以及上述指标患侧和健侧之间的差值,并进一步进行组内比较分析。构建联合模型,利用Cox回归分析评估冠状位角度波动与关节功能恢复情况的关系。利用最小绝对收缩选择算子回归法和多因素Logistic回归分析影响患者关节功能恢复的危险因素。按踝穴冠状位角度从低到高等分为5分位数组(Q1-Q5),比较5组患者的临床资料特征,并采用多因素Logistic回归分析踝穴冠状位角度变化与关节功能恢复不良风险的相关性,建立限制性立方样条Logistic回归模型分析其剂量-反应关系。建立回归方程y=1-1/(1+e^(-z))预测模型并进行验证。结果与结论:①患者患侧的踝穴宽度和深度、冠状位角度及矢状位角度均显著大于健侧(P均<0.05);且与优良组患者相比,可差组患者踝穴宽度差值、深度差值、冠状位角度差值及矢状位角度差值均更大(P<0.05);②联合模型显示无论冠状位角度是否在正常范围内,冠状位角度每纵向增加1˚,关节功能恢复不良的风险增加3%;③最小绝对收缩选择算子回归和多因素Logistics回归分析显示,调整潜在混杂因素后发现年龄过大、早期功能锻炼BACKGROUND:The morphological indexes of ankle point may change after ankle fracture,and there is a certain correlation between the coronal angle change of ankle point and the functional recovery of ankle joint.Most previous studies have studied the height recovery of ankle point after surgery,so the correlation between the fluctuation of coronal angle of ankle point and the functional recovery of ankle joint after ankle fracture has certain reference significance.OBJECTIVE:To investigate the effect of coronal angle change of ankle point on joint function recovery after ankle fracture.METHODS:A total of 86 patients with ankle fracture who underwent surgical treatment were selected as the study objects,and were divided into excellent group(n=45)and poor group(n=41)according to the results of American Orthopaedic Foot&Ankle Society(AOFAS)hindfoot-ankle score during the last follow-up,and the general data of the two groups were compared.The morphological indexes of ankle points on the affected side and healthy side were compared after surgery based on ankle acupoints and lateral X-rays of the ankle joint,including the width and depth of ankle points,coronal angle and sagittal angle,and the difference of ankle points between the affected side and healthy side,and further comparison and analysis were conducted in each group.A joint model was constructed and Cox regression analysis was used to evaluate the relationship between coronal angle fluctuation and joint function recovery.Least absolute shrinkage and selection operator regression method and multivariate Logistic regression were used to analyze the risk factors affecting the recovery of joint function.The patients were divided into 5-quartile array(Q1-Q5)according to the angle of coronal position at ankle point from low to high.The clinical data characteristics of the five groups were compared,and the correlation between the change of coronal position at ankle point and the risk of poor recovery of joint function was analyzed by multivariate Logistic regression.A

关 键 词：踝关节骨折 踝穴 冠状位角度 关节功能 Logistic回归分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R684.1