影响旋后外旋型Ⅱ度及以上踝关节骨折术后功能恢复的多因素分析  

Multivariate analysis of influencing functional recovery after ankle fracture of typeⅡand above supination-external rotation

作　　者：黄春桂 马亚飞 王军全 HUANG Chun-gui;MA Ya-fei;WANGJun-quan(Department of Traumatic Orthopaedics,Affiliated Hospital of Qinghai University,Xining810000,Qinghai,China;Department of Orthopaedics,the First People's Hospital of Tianshui City,Tianshui741000,Gansu,China)

机构地区：[1]青海大学附属医院骨科,青海西宁810000 [2]天水市第一人民医院骨科,甘肃天水741000

出　　处：《中国骨伤》2024年第9期910-916,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨旋后外旋型Ⅱ度及以上踝关节骨折术后功能恢复的影响因素。方法:回顾性分析2019年2月至2021年4月收治的120例旋后外旋型Ⅱ度及以上踝关节骨折患者的临床资料。根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足-后踝评分分为优组(90~100分)73例,良组(75~89分)35例,可组(<50分)12例。比较3组末次随访时踝关节活动度(range of motion,ROM)及并发症发生情况。对影响旋后外旋型踝关节骨折术后功能恢复的相关因素行单因素分析,将单因素分析中差异有统计学意义的结果进行多因素Logistic回归分析。结果:优组与良、可组术后关节ROM(背伸、跖屈、内翻、外翻)以及并发症比较,差异有统计学意义(P<0.05)。单因素分析结果显示,3组年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定、未放置引流管、存在感染、抗生素使用时间≥7 d组间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥50岁[OR=2.829,95%CI(1.049,7.628),P=0.040]、旋后外旋型Ⅳ度骨折[OR=6.13,95%CI(1.153,32.593),P=0.033],合并下胫腓韧带损伤螺钉内固定[OR=10.785,95%CI(3.338,3.894),P=0.000]、合并后踝骨折“T”形钢板固定[OR=6.349,95%CI(1.869,21.560),P=0.003]是影响旋后外旋型踝关节骨折术后功能恢复的独立危险因素(P<0.05)。结论:踝关节骨折术后结局为优者其ROM恢复较佳;年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定均影响旋后外旋型踝关节骨折术后功能恢复的危险因素。临床可对这些影响因素采取有效的应对措施,以改善其术后功能恢复,防止相关并发症的发生。Objective To explore influencing factors of functional recovery after ankle fracture of typeⅡdegree and above supination-external rotation.Methods Clinical data of 120 patients with ankle fractures of typeⅡdegree and above supination-external rotation admitted from February 2019 to April 2021 were retrospectively analyzed.According to American Orthopaedic Foot and Ankle Society(AOFAS),patients were divided into excellent group with 73 patients(90 to 100 points),good group with 35 patients(75 to 89 points),and fair group with 12 patients(<50 points).The differences of ankle active range of motion(ROM)and AOFAS score were compared among three groups at the latest follow-up.Multivariate Logistic regression analysis was performed to analyze the factors related to functional recovery after ankle fracture of supination-external rotation.Results There were significant differences in postoperative ROM(dorsoextension,plantar flexion,varus and valgus)and complications between excellent group and good and acceptable group(P<0.05).Univariate analysis showed there were differences in age above 50 years old,Ⅳdegree of supination-external rotation fracture,lower tibiofibular ligament injury,posterior ankle fracture,no drainage tube placed,infection,antibiotic use time above 7 days(P<0.05).Multivariate Logistic regression analysis showed age above 50 years old[OR=2.829,95%CI(1.049,7.628),P=0.040],Ⅳdegree fracture of supination-external rotation[OR=6.13,95%CI(1.153,32.593),P=0.033],lower tibiofibular ligament injury[OR=10.785,95%CI(3.338,34.894),P=0.000],and posterior ankle fracture[OR=6.349,95%CI(1.869,21.560),P=0.003]were independent risk factors for functional recovery after ankle fracture of supination-external rotation(P<0.05).Conclusion The postoperative excellent outcome of ankle fracture was good,and the recovery of joint motion was better.The older age of patient,Ⅳdegree of supination-external rotation fracture,the lower tibiofibular ligament injury,and posterior ankle fracture are all adverse factors affecting

关 键 词：踝关节骨折 旋后外旋型 后踝骨折 多因素分析 

分 类 号：R683.4[医药卫生—骨科学]