【摘要】 目的 分析踝关节骨折术后踝穴形态变化与踝关节功能的相关性及影响因素。方法 回顾性选取2019年1月至2023年1月入蚌埠市第一人民医院的36例踝关节骨折术后患者为研究对象，末次随访时参考Mazur评分法评估患侧踝关节功能，根据评估结果分为观察1组(<87分，可、差)9例、观察2组(87～92分，良)8例和观察3组(93～100分，优)19例。比较3组患者末次随访时健、患侧踝穴形态相关指标(矢状位角度、冠状位角度、踝穴深度、踝穴宽度)差值；踝关节功能、活动度与踝穴形态变化指标的关系用Pearson相关性分析法予以分析，同时对踝关节功能恢复产生影响的独立危险因素予以多元有序Logistic回归分析。结果 36例踝关节骨折患者的患侧冠状位角度、矢状位角度、踝穴深度、踝穴宽度明显高于健侧，差异均有统计学意义(P<0.05),且患者患侧跖屈肌力、背屈肌力、跖屈活动度、背屈活动度较健侧更低，差异均有统计学意义(P<0.05)。观察1、2、3组患者末次随访时患侧、健侧的冠状位角度、矢状位角度、踝穴深度、踝穴宽度差值之间差异均有统计学意义(P<0.05)。Pearson相关性分析显示，踝关节骨折术后患者患侧冠状位角度、矢状位角度、踝穴深度、踝穴宽度与患侧跖屈肌力、背屈肌力、跖屈活动度、背屈活动度呈负相关(P<0.05)。多元有序Logistic回归分析显示，踝关节骨折患者术后功能恢复的独立影响因素为年龄60岁以上、骨折分型C型、开始康复时间超过7 d、未接受跟骨牵引处理、踝穴形态指标(健侧与患侧之间的冠状位角度、矢状位角度、踝穴深度差值大、踝穴宽度差值大)。结论 踝关节骨折术后踝穴形态变化与踝关节功能及活动度呈负相关，患者术后踝关节功能下降的独立影响因素主要为C型骨折、康复训练开始时间过晚、未接受跟骨牵引处理、高龄及健侧与患侧之间的冠状位角度、矢状位角度、踝穴深度、踝穴宽度差值增大，临床上应重视此类踝关节骨折患者的对症治疗，以达最佳疗效。更多还原

【Abstract】 Objective To analyze the correlation and influencing factors between the morphological changes of ankle points and ankle function after ankle fracture operation. Methods Thirty-six patients with after ankle fracture operation admitted to Bengbu First People’s Hospital from January 2019 to January 2023 were selected as the research object, and the ankle function of the affected side was evaluated by Mazur score before operation. According to the evaluation results, 9 patients were divided into observation group 1(<87 points, fair and poor), observation group 2(87-92 points, good) and observation group 3(93-100 points, excellent). The differences of morphological indexes(sagittal angle, coronal angle, ankle point depth and ankle point width) between healthy and affected sides were compared among the three groups at the last follow-up. Pearson correlation analysis was used to analyze the relationship between ankle joint function, range of motion and morphological change indexes of ankle points, and multivariate ordered logistic regression analysis was used to analyze the independent risk factors affecting ankle joint function recovery. Results The coronal angle, sagittal angle, ankle point depth and ankle point width of 36 patients with ankle fracture were significantly higher than those of the healthy side(P<0.05), and the plantar flexion strength, dorsiflexion strength, plantar flexion activity and dorsiflexion activity of the affected side were lower than those of the healthy side(P<0.05). There were significant differences in the coronal angle, sagittal angle, ankle point depth and ankle point width between the affected side and the healthy side in the last follow-up of observation groups 1, 2 and 3(P<0.05). Pearson correlation analysis showed that the coronal angle, sagittal angle, ankle point depth and ankle point width were negatively correlated with plantar flexion strength, dorsiflexion strength, plantar flexion activity and dorsiflexion activity(P<0.05). Logistic regression analysis showed that the independent influencing factors of postoperative functional recovery of patients with ankle fracture were age over 60 years, fracture classification type C, postoperative rehabilitation time exceeded 7 days, patients who did not receive calcaneal traction treatment, and ankle point morphological indexes(the coronal angle, sagittal angle, ankle point depth and ankle point width difference between the healthy side and the affected side were large). Conclusion The morphological changes of ankle point after ankle fracture were negatively correlated with ankle function and mobility. The independent influencing factors of postoperative ankle function decline were mainly C-type fracture, late start time of rehabilitation training, no calcaneal traction treatment, advanced age, and increased coronal angle, sagittal angle, ankle point depth and ankle point width difference between healthy side and affected side. Clinical attention should be paid to the symptomatic treatment of such ankle fracture patients to achieve the best effect.更多还原