无手术指征的跟骨骨折保守治疗后致踝关节僵硬高危因素浅析

发布时间：2018-04-02 18:50

本文选题：跟骨骨折　切入点：关节僵硬　出处：《成都体育学院》2017年硕士论文

【摘要】：目的:分析保守治疗无手术指征的跟骨骨折并发踝关节僵硬的高危因素。方法:搜集全部来源于四川省骨科医院康复科在2011年-2016年期间诊治的无手术指征型跟骨骨折患者,总共搜集有患者129例(131足),其中并发踝关节僵硬者64例(病发率为48.8%)。将129例(131足)患者治疗过程中的信息资料采集,并将之分类、整理、列表统计、编码,之后采用logistic单因素回归分析法,分别对患者年龄、性别、跟骨骨折类型、是否有同侧踝关节周围损伤、外固定制动时间等前后12个临床评估因素与患者是否踝关节僵硬的关系进行分析,对于有意义(P0.05)的相关因素进行直接检验,综合汇总,并进一步运用logistic多因素分析后退法进行进一步分析,最终进入方程的因素即为无手术指征型跟骨骨折保守治疗后并发踝关节僵硬的高危因素。最后根据各高危因素的OR值[Exp(B)]和B值来确定各因素与踝关节僵硬并发的相关程度。结果:1、通过logistic单因素回归分析和检验得出有无同侧踝关节周围损伤、康复治疗的介入时间、外固定制动时间、跟距关节面恢复质量以及规范的康复指导为导致踝关节僵硬的相关因素;2、经logistic多因素回归分析得出导致踝关节僵硬的高危因素为:合并同侧踝关节周围损伤、外固定制动时间长、跟距关节面恢复质量差及康复治疗介入时间晚。3、对比各自的OR值和B值,得出最高危因素为合并同侧踝关节周围损伤(OR值35.008),其次为跟距关节面恢复质量差(OR值12.526),而康复治疗介入时间晚和外固定制动时间长之间相对差异较小,关系为外固定制动时间(OR值3.813)影响大于康复治疗介入时间(OR值3.158)。结论:面对踝关节僵硬的高病发率,预防相对于治疗显然更应该值得令人注意,经本研究分析,无手术指征的跟骨骨折保守治疗后致踝关节僵硬的高危因素包括:合并同侧踝关节周围损伤、跟距关节面恢复质量差、制动时间长以及康复治疗介入时间晚;因此,对于同侧踝关节合并多处损伤和跟距关节面恢复质量不良的患者,应多加强医患病情沟通,对此类疾病的预后多加以评判和预估,避免不必要的医患冲突,加强医患共同面对和战胜疾患的信心;另外,当大量研究和临床都提示无手术指征的稳定性骨折应予以长期外固定制动为主的治疗方式时,本研究发现,长时间的外固定制动、休养是导致患肢关节僵硬的一大高危因素,而缩短患肢外固定的制动时间,尽早的进行专业的康复治疗却可能降低僵硬的并发率。尤其是在功能至上的今日。
[Abstract]:Objective: to analyze the high risk factors for conservative treatment of calcaneal fracture with ankle stiffness.Methods: all the patients with nonoperative calcaneal fracture were collected from rehabilitation department of Sichuan Orthopedic Hospital from 2011 to 2016. A total of 129 cases (131 feet) with ankle stiffness were collected, among which 64 cases were complicated with ankle stiffness (the incidence rate was 48.8%).The information of 129 patients with 131feet was collected, classified, sorted, tabulated and coded. The age, sex and type of calcaneal fracture were analyzed by logistic single factor regression analysis.The relationship between 12 clinical evaluation factors before and after the ipsilateral ankle joint injury, the immobilization time of external fixation and whether the ankle joint was stiff or not was analyzed. The relevant factors of significant ankle joint were directly tested and summarized.The regression method of logistic multivariate analysis was used for further analysis. The factors that entered the equation were the high risk factors of ankle stiffness after conservative treatment of nonoperative calcaneal fracture.Results: 1. By logistic single factor regression analysis and test, the interventional time, external fixation and immobilization time of ipsilateral ankle joint injury, rehabilitation treatment and external fixation were obtained.The immobilization time of external fixation was long, the recovery quality of talus articular surface was poor and the interventional time of rehabilitation treatment was late. The OR value and B value were compared.The results showed that the most high risk factors were associated with ipsilateral ankle injury (OR = 35.008), followed by poor quality recovery (OR = 12.526). However, there was little difference between the late intervention time of rehabilitation treatment and the long immobilization time of external fixation.The relationship was that the OR value of immobilization time was 3.813) which was greater than that of rehabilitation therapy.Conclusion: in the face of the high incidence of ankle stiffness, prevention is obviously more worthy of attention than treatment.The high risk factors for ankle stiffness caused by conservative treatment of calcaneal fracture without surgical indication include: associated with ipsilateral ankle joint injury, poor quality of calcaneal articular surface recovery, long immobilization time and late intervention time for rehabilitation.For patients with ipsilateral ankle joint combined with multiple injuries and poor quality of heel articular surface restoration, the communication between doctors and patients should be strengthened, the prognosis of such diseases should be evaluated and predicted, and unnecessary conflicts between doctors and patients should be avoided.Recuperation is a high risk factor leading to joint stiffness of the affected limb, but shortening the immobilization time of external fixation of the affected limb and carrying out professional rehabilitation treatment as soon as possible may reduce the rate of stiffness.Especially in the function-oriented today.
【学位授予单位】：成都体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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