三踝骨折术后创伤性关节炎和功能预后的危险因素分析

Risk factors for traumatic arthritis and functional outcomes of trimalleolar fractures

背景:三踝骨折在踝关节骨折中很常见,预后也较差。目前对三踝骨折中后踝骨块的治疗没有统一的标准,后踝骨块对三踝骨折预后的影响还需进一步探索。目的:探讨三踝骨折术后创伤性关节炎和功能预后的危险因素。方法:回顾性分析2013年3月至2019年3月接受手术治疗的踝关节三踝骨折患者94例。通过术后X线片进行骨关节炎评分。末次随访时采用Olerud和Molander踝关节骨折疗效评分(OMAS)、美国矫形外科足踝协会踝-后足评分(AOFAS)和疼痛视觉模拟评分(VAS)来评价功能结果。采用logistic回归分析筛选三踝骨折术后创伤性关节炎和功能预后的危险因素。结果:所有患者均完成了术后骨关节炎评分,91例患者完成了术后功能评分。随访时间57.0(32.4,73.9)个月。后踝骨折块的面积为18.4%(0.6%,54.0%)。39例患者(41.5%)后踝骨块面积比>20%。43例患者(45.7%)出现术后复位不良。Logistic回归分析结果显示,后踝骨块面积比>20%及复位不良是三踝骨折术后创伤性关节炎的独立危险因素(P<0.05);复位不良和骨关节炎评分>1是三踝骨折术后功能预后的独立危险因素(P<0.05)。结论:提高后踝骨块的复位质量,降低后踝骨块的固定阈值可减少三踝骨折术后远期创伤性关节炎的发生,从而可预防远期功能结果不佳。

Background:Trimalleolar fractures are very common in the ankle fractures with poor prognosis.There is no standard treatment about posterior malleolar fractures in trimalleolar fractures.It is essential to explore the effect of posterior malleolus on the prognosis of trimalleolar fractures.Objective:To analyze the risk factors for traumatic arthritis and functional outcomes of trimalleolar fractures.Methods:A retrospective analysis was performed in 94 patients with trimalleolar fractures grade.The Olerud-Molander Ankle Score(OMAS),American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS)and Visual Analogue Scale(VAS)were used to evaluate functional results.Logistic multivariate analysis was used to analyze the risk factors of traumatic arthritis and functional prognosis after trimalleolar fractures.Results:All the patients underwent the evaluation of osteoarthritis grade and 91(84.3%)patients completed functional assessment.The median followup time was 57.0(32.4,73.9)months.The mean ratio of area of posterior malleolus fragment was 18.4%(0.6%,54.0%).The ratio of area of posterior malleolus fragment>20%was found in 39(41.5%)patients.Malreduction occurred in 43(45.7%)patients after surgery.Logistic multivariate analysis showed that the ratio of area of posterior malleolus fragment>20%and malreduction were two independent risk factors for traumatic arthritis after trimalleolar fractures(P<0.05).Malreduction and osteoarthritis grade>1 were independent risk factors for poor functional prognosis after trimalleolar fractures(P<0.05).Conclusions:It is recommended to improve the reduction quality of the posterior malleolar fragment and reduce the fixation threshold of the posterior malleolar fragment in order to reduce the occurrence of long-term traumatic arthritis and prevent poor functional outcome.