踝关节骨折的手术治疗效果及预后影响因素分析

Analysis of surgical treatment effect and factors affecting prognosis of ankle fractures

目的分析踝关节骨折的手术治疗效果及预后影响因素。方法纳入270例踝关节骨折合并下胫腓联合分离患者,均行切开复位内固定术。随访12个月,观察患者的治疗效果,计算踝关节功能优良率。将随访后踝关节功能“优”和“良”的患者纳入预后良好组,踝关节功能“可”和“差”的患者纳入预后不佳组,分析踝关节骨折的预后影响因素。结果术后12个月,患者的踝关节功能优良率为87.78%(237/270)。随访中,患者的并发症总发生率为6.67%(18/270)。术后12个月,270例患者均获得骨性愈合,73例患者取出内固定物。二元Logistic回归分析结果显示,年龄≥60岁、未行下胫腓联合修复、内固定物未取出和术后发生并发症均为影响踝关节骨折患者预后的独立危险因素(P<0.05)。结论切开复位内固定术治疗踝关节骨折的疗效确切。建议对合并下胫腓联合分离的患者术中开展下胫腓联合修复,以促进术后踝关节稳定性的提高;术后应根据患者恢复情况,开展内固定物取出术;同时围术期应积极采取措施,减少并发症的发生,以促进患者踝关节功能的恢复。

Objective To analyze the surgical treatment effect and factors affecting prognosis of ankle fractures.Methods A total of 270 cases of ankle fractures patients complicated with separation of the inferior tibiofibular syndesmosis were enrolled and treated with open reduction and internal fixation.The patients were followed up for 12 months to observe the therapeutic effect and calculate the excellent and good rate of ankle function.The patients with"excellent"and"good"of ankle function after follow-up were included in good prognosis group,and the patients with"fair"and"poor"of ankle function were included in poor prognosis group.The factors affecting prognosis of ankle fractures were analyzed.Results Twelve months after operation,the excellent and good rate of ankle function was 87.78%(237/270).During the follow-up,the total incidence of complications was 6.67%(18/270).Twelve months after operation,270 patients achieved bone healing,and the internal fixation was taken out in 73 patients.The binary Logistic regression analysis result showed that age≥60 years old,no lower tibiofibular syndesmosis repair,no removal of internal fixation and postoperative complications were independent risk factors affecting the prognosis of patients with ankle fractures(P<0.05).Conclusion Open reduction and internal fixation is effective in the treatment of ankle fractures.It is suggested to carry out lower tibiofibular syndesmosis repair in patients with separation of the inferior tibiofibular syndesmosis,so as to improve the stability of ankle joint after operation;the removal of internal fixation should be carried out according to the recovery of patients.Meanwhile,measures should be taken actively in the perioperative period to reduce the occurrence of complications,so as to promote the recovery of ankle function of patients.