發(fā)布時(shí)間：2019-05-14 08:52

【摘要】：目的:分析影響踝關(guān)節(jié)術(shù)后療效的各種相關(guān)影響因素,總結(jié)相關(guān)經(jīng)驗(yàn),為臨床醫(yī)師治療踝關(guān)節(jié)骨折提供參考。方法:分析于2012年6月~2016年3月就診于蘭州大學(xué)第二醫(yī)院骨科并行手術(shù)治療的踝關(guān)節(jié)骨折患者123例,根據(jù)患者的隨訪資料,選取可能影響踝關(guān)節(jié)骨折手術(shù)療效的因素,(1)一般資料和既往情況:性別、年齡、是否患有糖尿病、吸煙史;(2)受傷情況:受傷類型、骨折分型(AO-Danish-Weber)、開放性損傷、骨折部位皮膚張力性水皰、血管損傷、神經(jīng)損傷;(3)術(shù)前準(zhǔn)備:踝關(guān)節(jié)CT檢查、是否行跟骨牽引、受傷時(shí)間至行手術(shù)時(shí)間;(4)手術(shù)情況:手術(shù)方式;(5)術(shù)后康復(fù)及并發(fā)癥:術(shù)后服用鈣劑、術(shù)后下地負(fù)重時(shí)間、傷口愈合情況。先行各可能相關(guān)因素的單因素Logistic回歸分析,對(duì)于分類資料單因素Logistic回歸等同于卡方檢驗(yàn),以確定單因素對(duì)結(jié)果的影響而不考慮各因素之間的相互影響;根據(jù)單因素Logistic回歸分析結(jié)果篩選出有統(tǒng)計(jì)學(xué)差異的影響因素,再將這些可能的影響因素納入多因素Logistic逐步回歸分析,以篩選出主要影響踝關(guān)節(jié)骨折術(shù)后療效的因素。結(jié)果:123例患者術(shù)后均獲得6~24月隨訪,平均時(shí)間(15.19±6.12)月,根據(jù)AO-Danish-Weber骨折分型將骨折分類,其中A型骨折34例,B型骨折45例,C型骨折44例;末次隨訪時(shí)根據(jù)Mazur踝關(guān)節(jié)功能評(píng)分標(biāo)準(zhǔn)評(píng)價(jià),優(yōu)30例,良47例,可29例,差17例,根據(jù)單因素Logistic回歸分析發(fā)現(xiàn)年齡、受傷類型、骨折分型、是否行跟骨牽引、是否行踝關(guān)節(jié)CT檢查、是否為開放性損傷、手術(shù)方式差異有統(tǒng)計(jì)學(xué)意義,P值、OR值及95%可信區(qū)間分別為:0.001,2.686(1.575~4.579);0.001,3.862(2.245~6.646);0.001,4.871(2.606~9.103);0.010,3.000(1.306~6.893);0.004,3.052(1.427~6.528);0.002,0.262(0.112~0.614);0.001,3.974(2.065~7.649)。再行這些因素的多因素logistic逐步回歸分析發(fā)現(xiàn)年齡、受傷類型、骨折分型、是否行跟骨牽引、是否有踝關(guān)節(jié)CT、是否為開放性損傷、手術(shù)方式差異有統(tǒng)計(jì)學(xué)意義,均為影響踝關(guān)節(jié)骨折術(shù)后踝關(guān)節(jié)功能的影響因素。P值、OR值及95%可信區(qū)間分別為0.014,2.688(1.225~5.898);0.004,3.334(1.453~7.651);0.025,3.048(1.148~8.092);0.027,4.099(1.174~14.313);0.039,3.499(1.064~11.509);0.023,0.176(0.039~0.784);0.049,2.798(1.003~7.809)。結(jié)論:年齡、骨折分型、受傷類型、是否為開放性損傷、是否行跟骨骨牽引、踝關(guān)節(jié)CT檢查、手術(shù)方式為影響踝關(guān)節(jié)骨折術(shù)后關(guān)節(jié)功能的主要影響因素。正確判斷骨折的類型、完善術(shù)前檢查明確骨折位置、骨折塊的大小、有無(wú)伴隨韌帶損傷,積極行術(shù)前輔助治療,改善軟組織條件,可以增強(qiáng)術(shù)后踝關(guān)節(jié)功能,最大可能的防止創(chuàng)傷性關(guān)節(jié)炎的發(fā)生。
[Abstract]:Objective: to analyze the related factors affecting the curative effect of ankle joint operation, and to summarize the relevant experience, so as to provide reference for clinicians in the treatment of ankle fracture. Methods: 123 patients with ankle fracture treated by orthopaedic surgery in the second Hospital of Lanzhou University from June 2012 to March 2016 were analyzed. According to the follow-up data of the patients, the factors that might affect the curative effect of ankle fracture were selected. (I) General information and past information: sex, age, diabetes, history of smoking; (2) injury: injury type, fracture classification (AO-Danish-Weber), open injury, skin tension blister at fracture site, vascular injury, nerve injury; (3) preoperative preparation: ankle joint CT examination, calcaneal traction, injury time to operation time, (4) operation condition: operation method; (5) postoperative rehabilitation and complications: taking calcium after operation, loading time after operation, wound healing. According to the single factor Logistic regression analysis of each possible related factor, the single factor Logistic regression of classified data is equivalent to chi-square test in order to determine the influence of single factor on the result without considering the interaction between each factor. According to the results of univariate Logistic regression analysis, the influencing factors with statistical difference were selected, and then these possible influencing factors were included in multivariate Logistic stepwise regression analysis in order to screen out the main factors that affected the postoperative curative effect of ankle fracture. Results: all the 123 patients were followed up for 6 ~ 24 months with an average time of (15.19 鹵6.12) months. According to the classification of AO-Danish-Weber fracture, 34 cases of type A fracture, 45 cases of type B fracture and 44 cases of type C fracture were classified. According to Mazur ankle function score, 30 cases were excellent, 47 cases were good, 29 cases were fair and 17 cases were poor. According to univariate Logistic regression analysis, age, type of injury, fracture type and calcaneal traction were found. Whether the ankle joint was examined by CT and whether it was open or not, the difference of operation mode was statistically significant. The P value, OR value and 95% confidence interval were 0.0012.686 (1.575 鈮，

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