| 术后Pilon骨折的临床结局及其影响因素分析 |
| 投稿时间：2017-07-30 修订日期：2017-10-07 点此下载全文 |
| 引用本文：杨滔,杨晓茂,张艳秋,朱静.术后Pilon骨折的临床结局及其影响因素分析[J].医学研究杂志,2018,47(5):89-93 |
| DOI：
10.11969/j.issn.1673-548X.2018.05.022 |
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| 基金项目:四川省卫生厅科研项目（100447） |
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| 中文摘要:目的 研究手术治疗后Pilon骨折的临床结局，进而分析其可能的影响因素。方法 选取2012年1月~2015年1月于笔者医院手术治疗的后Pilon骨折患者38例为研究对象。记录患者出院时红细胞计数（RBC）、白细胞计数（WBC）、血清白蛋白（ALB）、空腹血糖（FPG）等临床资料。对所有患者进行为期2年的随访，根据患者末次随访时Burwell-Charnley影像学标准及AOFAS踝与后足功能评分标准对患者进行分组，两项评价指标均达到优良定义为预后良好组，其余纳入预后不良组。根据患者术后并发症情况绘制Kaplan-Meier生存曲线，对其临床结局进行分析，并应用单因素分析及多因素Cox回归确定其影响因素。结果 患者2年内不良临床结局的发生率为30.56%，并发症主要为创伤性关节炎，内固定失效，疼痛难以忍受行内固定取出。单因素分析显示，年龄、WBC、ALB、FPG对后Pilon骨折术后临床结局有影响（P<0.05），多因素Cox回归显示，年龄（RR=1.402，P=0.030）、FPG （RR=3.159，P=0.046）对后Pilon骨折术后临床结局存在明显影响，FPG对患者临床结局影响较大且高于年龄（RR=3.159 vs RR=1.402）。结论 手术治疗后Pilon骨折的临床结局尚可，年龄和FPG对手术治疗后Pilon骨折的临床结局存在明显影响，FPG有望作为后Pilon骨折患者不良预后的检测指标之一，具有潜在临床预测价值。 |
| 中文关键词:后Pilon骨折 临床结局 影响因素 |
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| Clinical Outcome of the Posterior Pilon Fractures after the Operation and Its Influencing Factors |
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| Abstract:Objective To study the clinical outcome of the posterior Pilon fractures after the operation and then analyze its possible influencing factors.Methods Totally 38 patients with the posterior post Pilon fractures who underwent surgical treatment from January 2012 to January 2015 were selected as the study subjects. Red blood cell(RBC), white blood cell count (WBC), serum albumin (ALB), fasting plasma glucose (FPG) and other clinical data were recorded when discharged. All patients were followed up for 2 years, and the patients were divided according to the Burwell-Charnley imaging criteria and the AOFAS ankle and hindfoot scoring criteria at the last follow-up. The patients whose both evaluations were excellent defined as the favorable prognosis group and the rest were poor prognosis group. Kaplan-Meier survival curve was drawn according to the postoperative complications. The clinical outcome was analyzed and the influencing factors were determined by univariate analysis and multivariate Cox regression.Results The incidence of adverse clinical outcomes was 30.56% in 2 years. The complications were mainly traumatic arthritis, internal fixation failure and the removing of the internal fixation because of the unbearable pain. Univariate analysis showed that age, WBC, ALB, FPG had an effect on the clinical outcome of the posterior Pilon fractures(P<0.05).Multivariate Cox regression showed that age (RR=1.402, P=0.030), FPG (RR=3.159,P<0.05) had a significant effect on the clinical outcome of the posterior pilon fractures,and FPG had a greater effect on the clinical outcome of patients than age(RR=3.159 vs RR=1.402).Conclusion The clinical outcome of the posterior Pilon fractures after the operation is tolerable, and the age and FPG has a significant effect on the clinical outcome of the posterior Pilon fractures after the operation,and FPG is hoped to be used as a indicator of predicting the prognosis of patients with the posterior Pilon fractures. |
| keywords:Posterior Pilon fractures Clinical outcome Influencing factor |
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