跟骨骨折术后疗效影响因素的相关分析

目的探讨影响跟骨骨折手术疗效的因素。方法回顾性分析2009年2月~2012年2月我科收治78例86足跟骨骨折行手术治疗的患者,按Maryland足部评分标准综合评定,并选取可能影响手术疗效的因素,如年龄、性别、骨折类型、开放与闭合、手术时机、切口类型、手术方式、关节内复位效果、是否植骨、术后Bhler角、部分负重时间等11项指标进行分组、赋值及单因素筛选和多因素Logistic回归分析。结果78例86足随访18~26个月,评价结果:优47足,良18足,可13足,差8足,优良率75.6%。其中,在骨折类型上将SandersⅡ型和Ⅲ型归为一组与Ⅳ型优良率分别为89.2%和33.3%;闭合骨折组68足(优良率80.9%),开放骨折组18足(优良率55.6%);骨折后2周内手术和2周后手术的优良率分别为87.0%、29.4%;关节内复位3mm组和≥3mm组优良率分别为87.7%、38.1%;术后Bhler角基本恢复者59足(优良率84.8%),27足复位欠满意(优良率55.6%);术后8周后部分负重与8周内部分负重优良率分别为87.1%、45.8%,以上组间均有差异,有统计学意义(P0.05)。通过单因素分析逐步剔除无关因素后进行多因素Logistic回归分析,显示跟骨骨折手术疗效的因素为骨折类型、手术时机、关节内复位效果、术后Bhler角。结论骨折类型、手术时机、关节内复位效果、术后Bhler角为影响跟骨骨折术后疗效的危险因素,临床上尽量避免影响疗效的不利因素,有助于改善手术疗效。

Analysis of factors related to calcaneal fracture function recovery by surgical treatments

Objective To explore factors related to calcaneal fracture function recovery by surgical treat -ments.Methods Seventy-eight patients with calcaneal fracture treated by operation from Feb .2009 to Feb.2012 in our department were retrospectively analyzed and comprehensively evaluated according to the Maryland Foot Score .Eleven factors that might affect the surgical curative effect including age ,gender ,fracture type ,open or closed type,operation time, types of incision, operation method, intra-articular reduction effect , bone graft, postoperative B?hler angle and partial weight-bearing time were grouped ,assigned and single factor screened with logistic regres-sion analysis.Results Patients were followed up for 18 to 26 months.Forty-seven cases were excellent,18 were good,13 were fair and 8 were poor.The excellent and good rate was 75.6%.Among them,Sanders type Ⅱ and type Ⅲfractures were grouped as one .The excellent and good rate was 89.2%in this group and 33.3%in typeⅣgroup.The open fracture group included 18 feet and the excellent and good rate was 55.6%.The closed fracture group included 68 feet and the excellent and good rate was 80.9%.The excellent and good rate was 87.0%within 2 weeks after surgery and 29.4%2 weeks after surgery .The excellent and good rate of the intra-articular reset <3mm group was 87.7%and 38.1%in the≥3mm group.Postoperative B?hler angle received basic recovery in 59 feet with an excellent and good rate of 84.8% and less satisfactory in 27 feet with an excellent and good rate of 55.6%.The excellent and good rate of postoperative weight-bearing group at 8 weeks after surgery and within 8 weeks after surgery were 87.1%and 45.8%respectively.All above data had statistical significance (P<0.05). Through single factor analysis ,irrelevant factors were eliminated .Multivariable logistic regression analysis showed that effective factors included fracture type ,operation time,surgery reduction effect and postoperative B?hler angle. Conclusion Fracture type,operation time,surgery reduction effect and postoperative B?hler angle are risk factors affecting the function recovery of calcaneal fracture .We should try to avoid adverse factors to improve the surgical curative effect .