切开复位治疗跟骨骨折伴跟骰关节脱位的临床疗效及并发症的预测

Clinical Efficacy and Prognostic Complication Prediction Model of Open Reduction Treatment of Calcaneal Fracture Complicated with Calcaneocuboid Joint Dislocation

目的:探究切开复位治疗跟骨骨折合并跟骰关节脱位的临床疗效及预后并发症预测模型的构建。方法:选取2014年6月至2023年6月收治的跟骨骨折合并跟骰关节脱位患者96例为研究对象,患者均采取切开复位治疗,分析其临床疗效,随访1年观察预后并发症发生情况。根据随访1年并发症情况分为并发症组(26例)和无并发症组(70例),通过单因素方差分析两组一般资料,并将有统计学差异的指标纳入二元Logistic回归模型,分析预后并发症发生相关影响因素。结果:96例患者均顺利完成手术,术后1年患者Gissane角低于术前,而跟骨结节关节角高于术前,差异有统计学意义(P<0.05)。96例患者中切口感染8例(8.3%),关节疼痛2例(2.1%),骨折移位1例(1.0%),深静脉血栓5例(5.2%),皮缘坏死7例(7.3%),距下关节炎1例(1.0%),软组织损伤2例(2.1%),预后并发症共发生26例(27.1%)。二元Logistic回归分析显示,吸烟、糖尿病、受伤至就诊时间(≥5 d)是预后并发症发生的危险因素,差异有统计学意义(P<0.05)。纳入上述因素建立研究模型的整体预测准确率为76.0%,通过Hosmer-Lemeshow拟合度检验显示模型拟合值和观测值的吻合程度一致(χ2=1.224,P=0.943)。利用Bootstrap法对模型进行验证曲线下面积(AUC)为0.787,95%CI为0.687~0.886,提示模型数据预测预后并发症发生准确性较好。结论:吸烟、糖尿病、受伤至就诊时间(≥5 d)是预后并发症发生的危险因素,基于上述相关因素建立风险预测模型具有较好预测价值。

Objective:To explore the clinical efficacy of open reduction treatment of calcaneal fracture combined with calcaneocuboid dislocation and the construction of prognostic complications prediction model.Methods:A total of 96 patients with calcaneal fracture combined with calcaneocuboid joint dislocation adimitted from June 2014 to June 2023 were selected as the study objects.All patients were treated with open reduction treatment.The clinical efficacy was analyzed and the incidence of prognostic complications was observed during 1-year follow-up.According to the 1-year follow-up and occurrence,the patients were divided into complication group(26 cases)and uncomplication group(70 cases).The general data of the two groups were analyzed by one-way ANOVA,and the indicators with statistical differences were included in the analysis of binary Logistic regression model to analyze the related influencing factors of the occurrence of prognostic complications.Results:The operation was successfully completed in 96 patients,and at 1 year postoperatively the patients' Gissane angle was lower than the preoperative one,whereas the angle of the calcaneal tuberosity joint was higher than the preoperative one(P<0.05).Of the 96 patients,incision infection was observed in 8 cases(8.3%),arthralgia in 2 cases(2.1%),displacement of fracture in 1 case(1.0%),deep vein thrombosis in 5 cases(5.2%),skin edge necrosis in 7 cases(7.3%),subtalar joint arthritis in 1 case(1.0%),and soft tissue injury in 2 cases(2.1%);a total of 26 cases(27.1%)occurred.Binary logistic regression analysis showed that smoking,diabetes mellitus,and injury-to-visit time(≥5 d)were risk factors for the occurrence of prognostic complications(P<0.05).The overall predictive accuracy of the research model created by incorporating the above factors was 76.0%,and the Hosmer-Lemeshow goodness-of-fit test showed a consistent agreement between the fitted and observed values of the model(χ2=1.224,P=0.943).Internal validation of the model using the Bootstrap method had an area under the curve(AUC)of 0.787 with a 95% CI of 0.6870.886,suggesting that the model data had good accuracy in predicting the occurrence of prognostic complications.Conclusion:Smoking,diabetes,time from injury to treatment(≥5 d),and time of detumescence are the risk factors for prognostic complications.Establishing a risk prediction model based on the above related factors has good predictive value.