踝关节骨折伴三角韧带损伤术后骨折延迟愈合的风险预测模型及护理对策  

Risk Prediction Model and Nursing Strategies for Delayed Union of Ankle Fractures with Triangular Ligament Injury After Surgery

作　　者：袁慧[1] 申艺萌 苏玉培 王培霞[1] YUAN Hui;SHEN Yimeng;SU Yupei;WANG Peixia(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Emergency Department,Zhengzhou Hospital of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院骨科,河南郑州450000 [2]郑州市中医院急诊科,河南郑州450000

出　　处：《河南医学研究》2024年第21期4004-4008,共5页Henan Medical Research

摘　　要：目的探讨踝关节骨折伴三角韧带损伤术后骨折延迟愈合的风险因素,进一步构建风险预测模型,为临床及时采取针对性护理对策提供依据。方法选取2020年1月至2023年6月郑州大学第一附属医院踝关节骨折伴三角韧带损伤术后骨折延迟愈合患者248例作为延迟组,同期选取术后骨折正常愈合患者265例作为未延迟组,收集两组资料,logistic回归分析踝关节骨折伴三角韧带损伤患者术后骨折延迟愈合的影响因素,进一步构建nomogram预测模型并进行验证。结果年龄、开放性骨折、内固定松动、骨质疏松、维生素缺乏、合并糖尿病、合并OSAHS、营养不良、激活素A是踝关节骨折伴三角韧带损伤患者术后骨折延迟愈合的危险因素,康复锻炼依从性、延续康复指导、术后中医药治疗、鸢尾素是其保护因素;nomogram预测模型预测术后骨折延迟愈合的曲线下面积(AUC)为0.874(95%CI:0.762~0.913),预测敏感度、特异度依次为86.75%、72.16%。结论延迟愈合是踝关节骨折伴三角韧带损伤患者术后常见问题,与多种因素有关,加强nomogram预测模型构建可及时识别高危人群,以此为依据及时采取针对性护理对策可能是促进骨折愈合、降低延迟愈合风险的新途径。Objective To explore the risk factors of delayed union of ankle fractures with triangular ligament injury after surgery,and further construct a risk prediction model to provide evidence for timely and targeted nursing interventions in clinical practice.Methods A total of 248 patients with delayed union of ankle fractures and triangular ligament injuries after surgery at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2023 were selected as the delayed group,and 265 patients with normal postoperative fracture healing were selected as the non-delayed group during the same period.The data of the two groups were collected,and logistic regression analysis was used to analyze the influencing factors of delayed union of ankle fractures and triangular ligament injuries after surgery.A nomogram prediction model was further constructed and validated.Results Age,open fracture,loose internal fixation,osteoporosis,vitamin deficiency,diabetes,OSAHS,malnutrition,activin A were risk factors for delayed union of ankle fractures with triangular ligament injury after surgery,while rehabilitation exercise compliance,continuation of rehabilitation guidance,postoperative traditional Chinese medicine treatment,and irisin were protective factors.The nomogram prediction model predicts that the area under the curve(AUC)of delayed union of fractures after surgery was 0.874(95%CI:0.762-0.913),with a sensitivity and specificity of 86.75%and 72.16%,respectively.Conclusion Delayed healing is a common problem in patients with ankle fractures and associated with the injury of the triangular ligament after surgery.It is related to multiple factors.Strengthening the construction of the Nomogram prediction model can identify high-risk populations in a timely manner,and based on this,targeted nursing strategies can be implemented to promote fracture healing and reduce the risk of delayed healing.

关 键 词：骨折 延迟愈合 预测模型 危险因素 护理对策 

分 类 号：R473.6[医药卫生—护理学]