踝关节骨折的治疗与踝关节功能预后影响因素分析

Analysis of Therapeutic Regimens for Ankle Joint Fractures and Influencing Factors of Joint Functions

目的：探讨踝关节骨折的治疗方法及影响踝关节功能的预后因素。方法：对自2005年1月至2008年12月以来采用手法复位石膏固定和切开复位手术治疗并得到随访的40例踝关节骨折者的临床资料进行回顾分析。按Lauge—Hansen分型，旋后外旋型27例，旋后内收型3例，旋前外展型2例，旋前外旋型6例，垂直压缩型（pilon骨折）2例。采用保守治疗10例，切开复位内固定治疗30例。按照美国足踝骨科协会（AOFAS）推荐的足踝评分系统评估治疗结果。对患者年龄、性别、合并伤、受伤至治疗时间、骨折类型等5个可能的相关因素进行多因素分析。结果：40例术后均获平均15个月（6～20个月）随访。按AOFAS评分平均97分。单因素Logistic回归分析发现年龄和骨折类型的差异有统计学意义，多因素Logistic逐步回归分析发现骨折类型的差异有统计学意义。结论：影响踝关节骨折后踝关节功能的主要预后因素是骨折类型，应主要根据这个因素采取个体化的治疗方法。

Objective：To analyze the therapeutic regimens for ankle joint fractures and the influencing factors of joint functions. Methods： The clinical data from 40 patients with ankle joint fractures, who received treatment from January 2005 to December 2008 and were followed up, was retrospectively analyzed. According to Lauge - Hansen classification, there were 27 cases of supination - extorsion, 3 of supination - endoduction, 2 of pronation - abduction, 6 of pronation - extorsion and 2 of vertical compression （ pilon fracture）. Ten patients accepted the expectant treatment and other 30 received the open reduction and internal fixation. The therapeutic results were evaluated by Ankle Hindfoot clinical Rating system of the American orthopaedic foot ＆ankle society （AOFAS）. The multiplicity was adopted to analyze the related factors including age, sex, the associated injury, the time interval from be injured to treated and classification of fracture. Results ： All the patients had been followed up for 6 to 20 months （ mean 15 months）. The average AOFAS scone was 97. The univariate logistic regression analysis showed that age and fracture type had a significant association with the prospective function of ankle joint. The multiple stepwise logistic regression showed that fracture type was key factors affecting the ankle function. Conclusions：Since fracture type of ankle joint is a chief prognostic factor affecting the joint function, it should be taken into consideration for the individualized treatment.