跟骨骨折术后踝及距下关节僵硬的发生因素分析

Causative Factors of Ankle and Subtalar Joint Stiffness after Calcaneals Surgery

目的:分析跟骨骨折手术后踝关节及距下关节僵硬发生的潜在影响因素。方法:跟骨骨折手术治疗98例,根据骨折畸形愈合的Stephens和Sanders的CT分型及踝关节和距下关节僵硬情况分为2组,观察组41例存在术后畸形愈合及见踝关节和距下关节僵硬,对照组57例正常愈合,比较受试对象一般信息及手术前后临床症状体征等特征信息,进行后足AOFAS功能评分,应用疼痛模拟评分(VAS)系统收集患者自评信息。对潜在影响踝关节和距下关节僵硬的因素进行回归分析。SPSS19.0统计软件包用于数据处理。结果:观察组9足出现伤足腓骨肌痉挛,占18.37%,高于对照组(P<0.05);观察组伤足腓骨肌腱粘连、伤足距下关节间隙狭窄高于对照组(P<0.05);两组术前AOFAS和VAS评分未见差别,治疗后均显著改善,且观察组评分分别高于对照组(P<0.05)。在单因素Logistic回归分析筛选变量的基础上,进行多因素Logistic回归分析,结果伤足腓骨肌痉挛、伤足腓骨肌腱粘连、伤足距下关节间隙狭窄及术前AOFAS评分和VAS的评分均为术后踝关节及距下关节僵硬发生的危险因素,OR值分别为1.230(1.125–1.345),1.507(1.398–1.625),1.056(1.045–1.066),1.178(1.108–1.252)和1.034(1.024–1.043)。结论:跟骨骨折手术后踝关节及距下关节僵硬发生受术前骨折伤情严重程度的影响,也同伤足腓骨肌功能状态、肌腱是否受到影响及伤足距下关节间隙狭窄有关。

Objective To investigate the potential influencing factors of ankle joint and subtalar joint stiffness after calcaneal fracture surgery.Methods A total of 98 patients were treated for calcaneal fractures.The patients were divided into two groups.The observation group consisted of 41 patients who had postoperative deformity and the ankle joint and subtalar joint stiffness.The control group comprised of 57 patients with normal healing.The clinical symptoms and signs of the two groups before and after surgery were analyzed,and the AOFAS function score was assessed.The patients’self-evaluation information was collected by the pain simulation score(VAS)system.The characteristics of the two groups were compared and the factors influencing the ankle and subtalar joint stiffness were analyzed retrospectively.SPSS19.0 statistical software package was used for data processing.Results The observation group showed that the proportion of peroneal muscular spasm was 18.37%,which was higher than that in the control group(P<0.05).In addition,the detection rate of peroneal tendon adhesion was observed in the observation group.The AOFAS score and VAS score of the two groups were similar before operation,and the scores were improved more in the observation group than those in control group after treatment(P<0.05).Multivariate logistic regression analysis was performed on the basis of univariate logistic regression analysis.The results showed that the peroneal muscle spasm,peroneal tendon adhesion,interosseous space narrowing,preoperative AOFAS score and VAS score were all the causative factors of ankle and subtalar joint stiffness after calcaneal fracture surgery.The OR values were 1.230(1.125–1.345),1.507(1.398–1.625),1.056(1.045–1.066),1.178(1.108–1.252)and 1.034(1.024–1.043),respectively.Conclusion The ankle joint and subtalar joint stiffness of calcaneal fractures is related to the severity of the injury before operation.It is also related to the function of the peroneal musculoskeletal muscle,and the effect of the injury on tendon and interosseous space.