[1]鲍沁蔚,刘亮,穆昕,等.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[J].中国中医骨伤科杂志,2024,32(11):42-47.[doi:10.20085/j.cnki.issn1005-0205.241109]
　BAO Qinwei,LIU Liang,MU Xin,et al.Clinical Efficacy and Prognostic Complication Prediction Model of Open Reduction Treatment of Calcaneal Fracture Complicated with Calcaneocuboid Joint Dislocation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(11):42-47.[doi:10.20085/j.cnki.issn1005-0205.241109]
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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()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年11期
页码:
42-47
栏目:
临床论著
出版日期:
2024-11-15

文章信息/Info

Title:
Clinical Efficacy and Prognostic Complication Prediction Model of Open Reduction Treatment of Calcaneal Fracture Complicated with Calcaneocuboid Joint Dislocation
文章编号:
1005-0205(2024)11-0042-06
作者:
鲍沁蔚1; 刘亮1; 穆昕1; 魏国华1; 刘峻宏1; 巫宗德1
1四川省骨科医院(成都,610041)
Author(s):
BAO Qinwei1; LIU Liang1; MU Xin1; WEI Guohua1; LIU Junhong1; WU Zongde1
1Sichuan Orthopedic Hospital,Chengdu 610041,China.
关键词:
跟骨骨折;  跟骰关节脱位;  切开复位;  预后并发症
Keywords:
calcaneus fracture;  calcaneocuboid joint dislocation;  open reduction;  prognostic complication
分类号:
R683.42
DOI:
10.20085/j.cnki.issn1005-0205.241109
文献标志码:
A
摘要:
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。
Abstract:
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.

参考文献/References:

[1] 林洪娇,黄志东,陈梅凤,等.酮咯酸氨丁三醇与布托啡诺对踝关节骨折术后镇痛效果、MMSE评分及血清NE、Cor含量的影响[J].贵州医科大学学报,2022,47(11):1344-1348.
[2] 郭宗慧,颜勇卿,唐寅,等.Sanders Ⅱ型跟骨骨折螺钉微创治疗的有限元优化分析[J].中国骨伤,2021,34(2):137-142.
[3] 张率功,张峰,宋远征,等.改良跗骨窦切口可塑形接骨板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折疗效观察[J].中国骨与关节损伤杂志,2021,36(10):1103-1105.
[4] 关鑫,相大勇,王博炜,等.跟骨矫形截骨术在跟骨骨折畸形愈合治疗中的应用进展[J].中华创伤骨科杂志,2022,24(1):38-45.
[5] DASARI S P,KERZNER B,FORTIER L M,et al.Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients:a systematic review and meta-analysis[J].Shoulder Elbow Surg,2022,31(4):884-894.
[6] 王于治,赵庆华,张珂.跗骨窦切口钢板内固定治疗Sanders Ⅱ型跟骨骨折[J].中国骨与关节损伤杂志,2021,36(10):1101-1103.
[7] 王琳,马玉林.跟骨骨折的诊断与治疗[J].宁夏医学杂志,2003,25(5):316-319.
[8] 于同军,张宇航,王磊,等.解剖锁定与普通钢板治疗闭合SandersⅡ、Ⅲ型跟骨骨折的病例对照研究[J].中国骨伤,2021,34(9):801-807.
[9] 明安世,成国祥,朱登峰,等.皮瓣间断牵开在跟骨骨折L形手术切口中的应用[J].中国骨伤,2023,36(4):320-325.
[10] 廖正文,黄承夸,陈仕,等.No-touch技术与传统拉钩治疗跟骨骨折疗效及术后切口并发症比较[J].中国骨伤,2023,36(4):302-308.
[11] 陈晔,孙焕建,施凤超,等.内外侧联合入路切开复位内固定术治疗合并载距突骨折脱位的跟骨骨折[J].中华骨科杂志,2022,42(3):172-181.
[12] 赵雁波,张晨阳,陈兴康,等.不同入路内固定治疗SandersⅢ型跟骨骨折的疗效[J].局解手术学杂志,2022,31(8):721-725.
[13] LUI T H.Avulsion fracture of the posterosuperior tuberosity of the calcaneus managed with lag screw fixation[J].Foot and Ankle Surgery,2018,5(1):45-48.
[14] 王明丽,赵爱军.双切口入路治疗跟骨骨折[J].临床骨科杂志,2022,25(2):232.
[15] GIORDANO V,GODOY-SANTOS A L,DE SOUZA F S,et al.Combined lag screw and cerclage wire fixation for calcaneal tuberosity avulsion fractures[J].Case Reports in Orthopedics,2018:6207024.
[16] PRABHAKAR G,KUSNEZOV N,RENSING N,et al.Dual fixation of calcaneal tuberosity avulsion with concomitant achilles tendon rupture:a novel hybrid technique[J].Case Rep Orthop,2017:9150538.
[17] RAUER T,TWERENBOLD R,FLüCKIGER R,et al.Avulsion fracture of the calcaneal tuberosity:case report and literature review[J].Foot Ankle Surg,2018,57(1):191-195.
[18] BLUM L E,HUNDAL R,WALTON D,et al.Percutaneous fixation of calcaneal tuberosity avulsion fracture[J].Orthop Trauma,2019,33(1):S44-S45.
[19] 王庆贤,陈伟,张英泽.25期跟骨骨折微创学习班核心内容概要[J].中华创伤杂志,2022,38(6):563-564.
[20] 张军,胡延春,白云亭,等.骨科机器人辅助经皮撬拨治疗跟骨骨折[J].中国微创外科杂志,2022,22(4):313-317.

备注/Memo

备注/Memo:
基金项目:四川省中医药管理局科学技术研究专项课题(2021MS371)
更新日期/Last Update: 2024-11-05