本文選題：跟骨骨折　切入點：關(guān)節(jié)僵硬　出處：《成都體育學(xué)院》2017年碩士論文

【摘要】：目的:分析保守治療無手術(shù)指征的跟骨骨折并發(fā)踝關(guān)節(jié)僵硬的高危因素。方法:搜集全部來源于四川省骨科醫(yī)院康復(fù)科在2011年-2016年期間診治的無手術(shù)指征型跟骨骨折患者,總共搜集有患者129例(131足),其中并發(fā)踝關(guān)節(jié)僵硬者64例(病發(fā)率為48.8%)。將129例(131足)患者治療過程中的信息資料采集,并將之分類、整理、列表統(tǒng)計、編碼,之后采用logistic單因素回歸分析法,分別對患者年齡、性別、跟骨骨折類型、是否有同側(cè)踝關(guān)節(jié)周圍損傷、外固定制動時間等前后12個臨床評估因素與患者是否踝關(guān)節(jié)僵硬的關(guān)系進行分析,對于有意義(P0.05)的相關(guān)因素進行直接檢驗,綜合匯總,并進一步運用logistic多因素分析后退法進行進一步分析,最終進入方程的因素即為無手術(shù)指征型跟骨骨折保守治療后并發(fā)踝關(guān)節(jié)僵硬的高危因素。最后根據(jù)各高危因素的OR值[Exp(B)]和B值來確定各因素與踝關(guān)節(jié)僵硬并發(fā)的相關(guān)程度。結(jié)果:1、通過logistic單因素回歸分析和檢驗得出有無同側(cè)踝關(guān)節(jié)周圍損傷、康復(fù)治療的介入時間、外固定制動時間、跟距關(guān)節(jié)面恢復(fù)質(zhì)量以及規(guī)范的康復(fù)指導(dǎo)為導(dǎo)致踝關(guān)節(jié)僵硬的相關(guān)因素;2、經(jīng)logistic多因素回歸分析得出導(dǎo)致踝關(guān)節(jié)僵硬的高危因素為:合并同側(cè)踝關(guān)節(jié)周圍損傷、外固定制動時間長、跟距關(guān)節(jié)面恢復(fù)質(zhì)量差及康復(fù)治療介入時間晚。3、對比各自的OR值和B值,得出最高危因素為合并同側(cè)踝關(guān)節(jié)周圍損傷(OR值35.008),其次為跟距關(guān)節(jié)面恢復(fù)質(zhì)量差(OR值12.526),而康復(fù)治療介入時間晚和外固定制動時間長之間相對差異較小,關(guān)系為外固定制動時間(OR值3.813)影響大于康復(fù)治療介入時間(OR值3.158)。結(jié)論:面對踝關(guān)節(jié)僵硬的高病發(fā)率,預(yù)防相對于治療顯然更應(yīng)該值得令人注意,經(jīng)本研究分析,無手術(shù)指征的跟骨骨折保守治療后致踝關(guān)節(jié)僵硬的高危因素包括:合并同側(cè)踝關(guān)節(jié)周圍損傷、跟距關(guān)節(jié)面恢復(fù)質(zhì)量差、制動時間長以及康復(fù)治療介入時間晚;因此,對于同側(cè)踝關(guān)節(jié)合并多處損傷和跟距關(guān)節(jié)面恢復(fù)質(zhì)量不良的患者,應(yīng)多加強醫(yī)患病情溝通,對此類疾病的預(yù)后多加以評判和預(yù)估,避免不必要的醫(yī)患沖突,加強醫(yī)患共同面對和戰(zhàn)勝疾患的信心;另外,當(dāng)大量研究和臨床都提示無手術(shù)指征的穩(wěn)定性骨折應(yīng)予以長期外固定制動為主的治療方式時,本研究發(fā)現(xiàn),長時間的外固定制動、休養(yǎng)是導(dǎo)致患肢關(guān)節(jié)僵硬的一大高危因素,而縮短患肢外固定的制動時間,盡早的進行專業(yè)的康復(fù)治療卻可能降低僵硬的并發(fā)率。尤其是在功能至上的今日。
[Abstract]:Objective: to analyze the high risk factors for conservative treatment of calcaneal fracture with ankle stiffness.Methods: all the patients with nonoperative calcaneal fracture were collected from rehabilitation department of Sichuan Orthopedic Hospital from 2011 to 2016. A total of 129 cases (131 feet) with ankle stiffness were collected, among which 64 cases were complicated with ankle stiffness (the incidence rate was 48.8%).The information of 129 patients with 131feet was collected, classified, sorted, tabulated and coded. The age, sex and type of calcaneal fracture were analyzed by logistic single factor regression analysis.The relationship between 12 clinical evaluation factors before and after the ipsilateral ankle joint injury, the immobilization time of external fixation and whether the ankle joint was stiff or not was analyzed. The relevant factors of significant ankle joint were directly tested and summarized.The regression method of logistic multivariate analysis was used for further analysis. The factors that entered the equation were the high risk factors of ankle stiffness after conservative treatment of nonoperative calcaneal fracture.Results: 1. By logistic single factor regression analysis and test, the interventional time, external fixation and immobilization time of ipsilateral ankle joint injury, rehabilitation treatment and external fixation were obtained.The immobilization time of external fixation was long, the recovery quality of talus articular surface was poor and the interventional time of rehabilitation treatment was late. The OR value and B value were compared.The results showed that the most high risk factors were associated with ipsilateral ankle injury (OR = 35.008), followed by poor quality recovery (OR = 12.526). However, there was little difference between the late intervention time of rehabilitation treatment and the long immobilization time of external fixation.The relationship was that the OR value of immobilization time was 3.813) which was greater than that of rehabilitation therapy.Conclusion: in the face of the high incidence of ankle stiffness, prevention is obviously more worthy of attention than treatment.The high risk factors for ankle stiffness caused by conservative treatment of calcaneal fracture without surgical indication include: associated with ipsilateral ankle joint injury, poor quality of calcaneal articular surface recovery, long immobilization time and late intervention time for rehabilitation.For patients with ipsilateral ankle joint combined with multiple injuries and poor quality of heel articular surface restoration, the communication between doctors and patients should be strengthened, the prognosis of such diseases should be evaluated and predicted, and unnecessary conflicts between doctors and patients should be avoided.Recuperation is a high risk factor leading to joint stiffness of the affected limb, but shortening the immobilization time of external fixation of the affected limb and carrying out professional rehabilitation treatment as soon as possible may reduce the rate of stiffness.Especially in the function-oriented today.
【學(xué)位授予單位】：成都體育學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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