张-侯氏骨折的影响因素分析

Analysis of the influencing factors of Zhang-Hou’s fracture

目的分析张-侯氏骨折发生的危险因素,为临床诊断提供参考价值。方法选择2016年1月至2021年12月遵义医科大学第三附属医院创伤骨科收治的196例胫骨中下1/3螺旋形骨折患者。按照有无合并后踝骨折,分为后踝组和非后踝组。记录并分析两组一般信息及影像学资料,采用logistic回归分析胫骨中下1/3螺旋形骨折合并后踝骨折的影响因素。结果后踝组胫骨骨折线长度、胫骨骨折线最低点至胫-距关节面距离、胫骨骨折线最低点至胫-距关节面距离占胫骨全长比例(以下简称“距离比”)大于非后踝组,差异有统计学意义(P<0.05)。胫骨骨折线长度、距离比是胫骨中下1/3螺旋形骨折合并后踝骨折的影响因素(OR>1,P<0.05)。结论胫骨中下1/3螺旋形骨折合并后踝骨折可能受多种因素影响,临床医师应密切关注胫骨骨折线长度、距离比,若以上指标较大,需警惕后踝骨折的发生,避免临床漏诊,给后期治疗埋下隐患。

Objective To analyze the influencing factors of Zhang-Hou’s fractures,and to provide reference value for clinical diagnosis.Methods From January 2016 to December 2021,196 patients with spiral fractures of the middle and lower 1/3 of tibia admitted to the Department of Orthopedics,the Third Affiliated Hospital of Zunyi Medical University were selected.They were divided into posterior malleolus group and non-posterior malleolus group according to the presence or obsence of posterior malleolus fracture.The general information and imaging data of two groups were recorded and analyzed,logistic regression was used to analyze the influencing factors of spiral fracture of the middle and lower 1/3 of the tibia combined with posterior malleolus fracture.Results The length of the tibia fracture line,the distance from the lowest point of the tibial fracture line to the tibial-talar surface,the distance from the lowest point of the tibial fracture line to the tibial-talar surface accounted for the proportion of the tibial total length(hereinafter referred to as“distance ratio”)in posterior malleolus group were greater than those in non-posterior malleolus group,and the differences were statistically significant(P<0.05).The length of the tibia fracture line and distance ratio were independent risk factors for the middle and lower 1/3 tibial spiral fracture combined with posterior malleolus fracture(OR>1,P<0.05).Conclusion The middle and lower 1/3 tibial spiral fracture complicated posterior malleolus fractures may be affected by various factors.Clinicians can pay close attention to the length of the tibial fracture line and distance ratio.If the above indicators are large,it is necessary to be alert to the occurrence of posterior malleolus fracture to avoid clinical missed diagnosis and bury hidden dangers for later treatment.