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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 736 -740. doi: 10.3877/cma.j.issn.1674-134X.2023.05.022

临床经验

踝关节骨折内固定术后形态变化及功能影响因素
周春林, 韩元龙†(), 丁飞, 吴玮杰   
  1. 226011　上海大学附属南通医院(南通市第六人民医院)骨科
  • 收稿日期:2023-03-17 出版日期:2023-10-01
  • 通信作者: 韩元龙

Analysis of ankle mortise morphological changes and function influencing factors after internal fixation of ankle fracture

Chunlin Zhou, Yuanlong Han†(), Fei Ding, Weijie Wu   

  1. Department of Orthopedics, Nantong Hospital Affiliated to Shanghai University (Nantong Sixth People's Hospital), Shanghai 226011, China
  • Received:2023-03-17 Published:2023-10-01
  • Corresponding author: Yuanlong Han
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引用本文：

周春林, 韩元龙, 丁飞, 吴玮杰. 踝关节骨折内固定术后形态变化及功能影响因素[J]. 中华关节外科杂志(电子版), 2023, 17(05): 736-740.

Chunlin Zhou, Yuanlong Han, Fei Ding, Weijie Wu. Analysis of ankle mortise morphological changes and function influencing factors after internal fixation of ankle fracture[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 736-740.

目的

探讨踝关节骨折切开复位内固定术后踝关节形态变化及其踝关节功能影响因素。

方法

选取2018年1月至2021年6月上海大学附属南通医院骨科收治的踝关节骨折并行切开复位内固定的患者，根据美国足与踝关节协会踝与后足功能(AOFAS)评分分为优组、良组及可与差组，并用多因素线性回归分析踝关节形态指标(包括踝关节宽度、踝关节深度、冠状位角度以及矢状位角度)与AOFAS的相关性。

结果

共纳入98例患者。踝关节形态变化：(1)与健侧比较，踝关节骨折切开复位内固定术后患者患侧踝关节宽度、深度以及冠状和矢状位角度均明显增大(t＝6.835、3.523、6.105、10.670，均为P< 0.05)。(2)踝关节骨折切开复位内固定术后患者踝关节功能AOFAS评分为(77±9)分。3组患者踝关节形态指标(包括踝关节宽度、深度、冠状位角度以及矢状位角度)的健患侧之差，差异均有统计学意义(F＝396.749、136.520、59.694、406.548，均为P< 0.05)。(3)术后患者的踝关节宽度、深度、冠状位以及矢状位角度的健患侧之差的水平均与踝关节功能AOFAS评分呈显著负相关(r＝－0.368，r2＝－0.398，r3＝－0.208，r4＝－0.423，均P< 0.05)。踝关节功能影响因素：(1)不同年龄、开始康复时间、坚持功能训练情况的AOFAS评分比较，差异有统计学意义(t＝2.460、3.549，均为P<0.05)；(2)年龄[B＝0.386，95%CI(0.207，0.565)，P<0.001]、坚持功能训练情况[B＝－9.623，95%CI(－15.118，－4.129)，P＝0.001]以及患侧和健侧踝关节宽度之差[B＝－1.200，95%CI(－1.785，－0.614)，P<0.001]为影响术后患者踝关节功能AOFAS评分的主要影响因素。

结论

踝关节骨折切开复位内固定术后患者的踝关节形态变化与其踝关节功能水平呈显著负相关。

关键词: 踝骨折, 骨折切开复位, 骨折固定术
Objective

To explore the changes in ankle mortise morphology and the influencing factors of ankle joint function after open reduction and internal fixation surgery for ankle joint fractures.

Methods

The patients with ankle fractures and accepted open reduction and internal fixation in the orthopedics d epartment of Nantong Hospital Affiliated to Shanghai University from January 2018 to June 2021 were selected and divided into the excellent group, the good group, and the fair to poor group based on the American Foot and Ankle Association ankle and posterior foot function score (AOFAS). Multiple factor linear regression analysis was used to analyse the relationship between AOFAS score and morphological indices of ankle joint( including the width, depth, coronal and sagittal angles).

Results

A total of 98 patients were enrolled. Changes in ankle morphology: (1) compared with the healthy side, the width, depth, and coronal and sagittal angles of the ankle on the affected side of patients with ankle fracture after open reduction and internal fixation were significantly increased(t=6.835, 3.523, 6.105, 10.670, all P<0.05). (2)AOFAS score of ankle joint function in patients with ankle fracture after open reduction and internal fixation surgery was (77±9). The differences in ankle shape indices between the healthy and sick sides of the three groups were statistically significant (F=396.749, 136.520, 59.694, 406.548, all P< 0.05). (3) The difference in morphological indices of ankle joint between the healthy and sick sides of postoperative patients was significantly negatively correlated with the AOFAS score of ankle joint function (r=-0.368, -0.398, -0.208, -0.423, all P< 0.05). Factors influencing ankle joint function: (1) comparison of AOFAS for different ages, start of rehabilitation, and adherence to functional training showed statistically significant differences (t=2.460, 3.549, both P<0.05). (2) Age[B=0.386, 95%CI(0.207, 0.565), P<0.001], adherence to functional training[B=-9.623, 95%CI(-15.118, -4.129), P=0.001], and the differences in ankle width between the affected and healthy sides [B=-1.200, 95%CI(-1.785, -0.614), P<0.001] were the main influencing factors on postoperative AOFAS scores of ankle joint function.

Conclusion

There is a significant negative correlation between the changes in ankle morphology and ankle joint function in patients after open reduction and internal fixation for ankle joint fractures.

Key words: Ankle fractures, Open fracture reduction, Fracture fixation
图2 切开复位内固定术术后X线，示骨折复位良好，关节面平整
Figure 2 Lateral view of X-ray of right ankle after open reduction and internal fixation, showing good fracture reduction and smooth joint surface
表1 踝关节形态变化(±s)
Table 1 Changes in ankle motise morphology
组别Groups 例数Case number 踝关节高度(mm)Ankle point height 踝关节宽度(mm)Ankle point width 踝关节深度(mm)Ankle point depth 冠状位角度(°)Coronal position angle 矢状位角度(°)Sagittal position angle
患侧Affected side 98 25.7±2.6 43.7±2.3 38.4±2.1 7.9±1.1 15.2±1.6
健侧Healthy side 98 25.6±2.4 41.3±2.8 37.3±2.1 6.8±1.1 13.1±1.4
t值   0.466 6.835 3.523 6.105 10.670
P值   >0.05 <0.001 0.001 <0.001 <0.001
表2 踝关节形态指标之差的比较(±s)
Table 2 Comparison of the differences in ankle point morphological indicators
组别Groups 例数Case number 踝关节高度差(mm)Difference in ankle height 踝关节宽度差(mm)Difference in ankle width 踝关节深度差(mm)Difference in ankle depth 冠状位角度差(°)Difference in coronal angle 矢状位角度差(°)Difference in sagittal angle
优Excellent 48 0.23±0.06 0.69±0.13 1.43±0.26 1.62±0.34 0.83±0.21
良Good 26 0.25±0.07 0.94±0.16 1.79±0.32 2.06±0.47 1.79±0.36
可、差Acceptable and poor 24 0.26±0.08 2.13±0.34 3.13±0.68 2.78±0.52 3.18±0.47
F值   1.765 396.749 136.520 59.694 406.548
P值   >0.05 <0.001 <0.001 <0.001 <0.001
表3 踝关节形态指标与其踝关节功能AOFAS评分的相关性
Table 3 Correlation between ankle point morphology indicators and ankle joint function AOFAS score
踝关节宽度差(mm)Difference in Ankle Point Width 踝关节深度差(mm)Difference in Ankle Point Depth 冠状位角度差(°)Difference in Coronal Angle 矢状位角度差(°)Difference in Sagittal Angle
r P r P r P r P
－0.368 <0.001 －0.398 <0.001 －0.208 0.026 －0.423 <0.001
表4 术后踝关节功能影响因素的单因素分析
Table 4 Single factor analysis of factors affecting postoperative ankle joint function
组别Groups 例数Case number 构成比(%)Composition ratio AOFAS评分(±s)AOFAS scores 统计值 P值
性别Gender          
男Male 55 56.1 77±9 t＝0.590 >0.05
女Female 43 43.9 76±8
年龄(岁)Age (years)          
18~39 25 25.5 83±8    
40~59 36 36.7 78±9 F＝11.888 <0.001
60~74 37 37.8 72±9    
文化程度Education level          
初中及以下Junior high school and below 35 35.7 79±9    
高中或中专High school or technical secondary school 34 34.7 77±9 F＝1.432 >0.05
大专及以上College or above 29 29.6 75±9    
婚姻状况Marital status          
已婚Married 77 78.6 77±9 t＝0.153 >0.05
未婚或者离异Unmarried or divorced 21 21.4 77±9
骨折分型Fracture classification          
A 21 21.4 78±9    
B 59 60.2 77±9 F＝0.286 >0.05
C 18 18.4 76±8    
开始康复时间Starting rehabilitation time          
≤7 d 61 62.2 79±9 t＝2.460 0.016
>7 d 37 37.8 74±9
跟骨牵引Calcaneal traction          
是Yes 65 66.3 78±9 t＝1.290 >0.05
否No 33 33.8 75±9
坚持功能训练情况Persist in functional training          
是Yes 63 64.3 79±9 t＝3.549 0.001
否No 35 35.7 73±9
表5 多因素分析
Table 5 Multivariate analysis
影响因素Influence factor B SE 95%CI t值 P值
常量constant 169.075 14.862 (139.548，198.601) 11.376 <0.001
年龄(ref. 18~39岁)Age (ref. 18－39 years old) 0.386 0.090 (0.207，0.565) 4.292 <0.001
开始康复时间(ref. ≤7 d)Time to start rehabilitation 0.017 0.031 (－0.045，0.078) 0.538 0.592
坚持功能训练情况(ref.否)Persist in functional training (ref.No) －9.623 2.766 (－15.118，－4.129) 3.480 0.001
患侧和健侧踝关节宽度差Difference in width between the affected and healthy ankle acupoints －1.200 0.295 (－1.785，－0.614) 4.071 <0.001
患侧和健侧踝关节深度差The difference in depth between the affected and healthy ankle acupoints 0.073 0.057 (－0.041，0.186) 1.272 0.207
患侧和健侧踝关节冠状位角度差Difference in coronal angle between the affected and healthy sides of the ankle acupoints 2.371 1.320 (－0.252，4.994) 1.796 0.076
患侧和健侧踝关节矢状位角度差Difference in sagittal angle between the affected and healthy ankle acupoints 0.812 1.034 (－1.242，2.866) 0.786 0.434
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