跟骨骨折后距下关节炎原位融合术的患者满意度影响因素分析

Analysis of the factors influencing patient satisfaction after in situ arthrodesis for subtalar arthritis after calcaneal fracture

目的:探讨跟骨骨折后距下关节炎原位融合术的临床疗效,并对术后患者满意度的影响因素进行分析。方法:回顾性选取2018年3月至2020年11月因跟骨骨折术后创伤性距下关节炎行距下关节原位融合术的59例患者,男51例,女8例,年龄26~71岁,平均(45.6±12.6)岁,根据术后随访结果,分为满意度低组和满意度高组。收集患者基线资料,术前术后临床资料和影像学资料,探讨性别、年龄、体重指数(BMI)、既往是否患有糖尿病、是否为工伤,术后是否恢复运动和工作及术后恢复运动和工作的时间,健侧高度与患侧高度差、术前踝关节健侧背伸与患侧差值、术前患侧距骨跟骨角度、术前患侧距骨倾斜角度,术前、术后美国足踝外科医师协会(AOFAS)评分及术前与术后AOFAS评分的差值,术前、术后负重下疼痛视觉模拟评分(VAS)及术前与术后负重下VAS评分的差值,是否完全骨性愈合、术后是否活动受限、是否持续存在术后麻木、术后是否疼痛、术后是否肿胀对患者满意度的影响。结果:随访时间6~48个月,平均(18.7±7.7)个月。术后AOFAS评分显著高于术前,负重下VAS评分显著低于术前(P<0.05)。满意度低组8例(13.6%),满意度高组患者51例(86.4%)。与满意度高组患者比较,满意度低组患者的术前AOFAS评分低、负重下VAS评分高、术后负重VAS评分高、不能恢复工作和运动的比例高。结论:距下关节原位融合术治疗跟骨骨折后距下关节炎的术后患者满意度影响因素包括术前AOFAS评分和负重下VAS评分、术后负重下VAS评分、术后能否恢复工作及运动。

Objective:To investigate the clinical efficacy of in situ arthrodesis for subtalar arthritis after calcaneal fracture and to analyze the influencing factors of postoperative satisfaction.Methods:A total of 59 patients who underwent subtalar joint arthrodesis due to traumatic arthritis of the subtalar joint after calcaneal fracture from March 2018 to November 2020 were retrospectively enrolled,including 51 males and 8 females,aged 26-71 years,with an average age of(45.6±12.6)years.Patients were divided into low satisfaction group and high satisfaction group according to the postoperative follow-up results.Baseline data,preoperative and postoperative clinical information and radiological data were collected,including gender,age,body mass index(BMI),history of diabetes,history of occupational injury,postoperative resumption of physical activity and work,and the time to postoperative resumption of physical activity and work,the height difference between the healthy and affected sides,the difference in dorsiflexion between the healthy and affected ankles preoperatively,the angle of the affected side subtalar joint preoperatively,the tilt angle of the affected side subtalar joint preoperatively,preoperative and postoperative AOFAS scores as well as difference between preoperative and postoperative AOFAS scores,preoperative and postoperative weight-bearing VAS scores,as well as difference between preoperative and postoperative weight-bearing VAS scores,complete bony union,postoperative activity limitations,persistent postoperative numbness,postoperative pain,swelling.The impacts of these factors on patient satisfaction were evaluated.Results:Patients were followed up for a duration ranging from 6 to 48 months,with a mean duration of 18.7±7.7 months.The postoperative AOFAS score was significantly higher than the preoperative score,and the weight-bearing VAS score was significantly lower than the preoperative score(P<0.05).There were 8 cases(13.6%)in the low satisfaction group and 51 cases(86.4%)in the high satisfaction group.Compared with the high satisfaction group,patients in the low satisfaction group exhibited lower preoperative AOFAS score,higher weight-bearing VAS score,higher postoperative weight-bearing VAS score,and a higher proportion of individuals unable to resume work and physical activity.Conclusions:Factors influencing satisfaction after in situ arthrodesis of subtalar arthritis after calcaneal fracture include preoperative AOFAS score,weight-bearing VAS score,postoperative weight-bearing VAS score,and postoperative inability to resume work and exercise.