人口学特征对Sanders Ⅲ型跟骨骨折临床疗效的影响

王亚鹏; 付炳金; 陈洁; 杜瑞; 朱晓东; 杨伟强; 孙广超

doi:10.7619/jcmp.20222022

人口学特征对Sanders Ⅲ型跟骨骨折临床疗效的影响

滨州医学院附属医院足踝外科, 山东滨州, 256603

基金项目:

跟骨骨折中距下关节融合相关因素临床研究基金资助项目 BY2021KJ12

详细信息

通讯作者:
孙广超, E-mail: sunguangchao1984@126.com

中图分类号: R687.3;R274.12
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- 文章访问数: 185
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- PDF下载量: 11
出版历程
- 收稿日期: 2022-06-29
- 网络出版日期: 2023-02-01

Influence of demographic characteristics in Sanders type Ⅲ calcaneal fracture

Department of Foot and Ankle Surgery, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, 256603

摘要

摘要:
目的
分析不同年龄及不同职业的Sanders Ⅲ型跟骨骨折临床预后的特点。
方法
采用回顾性队列研究设计选取2016年1月—2018年12月110例行切开复位内固定手术治疗的SandersⅢ型跟骨骨折患者，收集并分析不同年龄、职业患者患肢恢复时间、美国足踝外科协会（AOFAS）踝-后足评分以及是否行二次距下关节融合术等指标。
结果
老年跟骨骨折患者恢复工作时间长于非老年患者，差异有统计学意义（P < 0.05）；重体力劳动职业患者跟骨骨折恢复工作时间长于轻体力患者，AOFAS踝-后足评分低于轻体力患者，差异均有统计学意义（P < 0.05）。年龄与职业对恢复工作时间的影响上存在正向相乘交互作用（P < 0.05），即2种因素同时存在的恢复工作时间远远长于因素单独作用。
结论
老年患者恢复工作时间长于非老年患者。重体力劳动职业患者相较于轻体力劳动职业患者恢复工作时间显著延长，且有较低的AOFAS踝-后足评分及较高的二期距下关节融合率。因此，对于迫切回到工作岗位的从事重体力劳动职业的老年Sanders Ⅲ型跟骨骨折患者，一期行距下关节融合术有助于更好地恢复患者正常生活和工作。
- 跟骨骨折 /
- 年龄 /
- 职业 /
- 距下关节融合术 /
- AOFAS踝-后足评分
Abstract:
Objective
To analyze the characteristics of clinical prognosis of calcaneal fracture of Sanders type Ⅲ in different ages and occupations.
Methods
A retrospective cohort study design was used to select 110 patients with Sanders type Ⅲ calcaneal fracture who underwent open reduction and internal fixation from January 2016 to December 2018. Age, occupational recovery time, American Society for Foot and Ankle Surgery (AOFAS) ankle-posterior foot score, and secondary subtalar joint fusion surgery were collected and analyzed.
Results
Elderly patients with calcaneal fracture had longer time than non-elderly patients (P < 0.05). The recovery time of calcaneus fracture in patients with heavy physical strength occupation was longer than that in patients with light physical strength occupation, and AOFAS ankle-posterior foot score was lower than that in patients with light physical strength occupation (P < 0.05). The effects of age and occupation on the return to work time were positively multiplied (P < 0.05), which indicated that the recovery time of the two factors was much longer than that of presence of the single factor.
Conclusion
Elderly patients have longer time to resume work than non-elderly patients. Patients with heavy physical strength occupation have significantly longer recovery time than those with light physical strength occupation, and are more likely to have lower AOFAS ankle-posterior foot score and higher secondary subtalar joint fusion rate. Therefore, for elderly patients with Sanders type Ⅲ calcaneal fracture who are engaged in heavy physical strength occupation and are eager to return to work, primary subspace arthrodesis is helpful to better restore patients'normal life and work.
- calcaneal fracture /
- age /
- profession /
- subtalar joint fusion /
- AOFAS ankle-posterior foot score

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表 1 不同年龄患者的基线特征比较[n(%)]

基线特征	分类	n	非老年组(n=82)	老年组(n=28)
性别	男	72	54(65.85)	18(64.29)
	女	38	28(34.15)	10(35.71)
职业	重体力劳动职业	45	35(42.68)	10(35.71)
	轻体力劳动职业	65	47(57.32)	18(64.29)
暴力强度	低暴力程度	29	9(10.98)^*	20(71.43)
	高暴力程度	81	73(89.02)^*	8(28.57)
术后并发症		6	4(4.88)	2(7.14)
与老年组比较, * P < 0.05

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表 2 不同职业患者的基线特征比较(x±s)[n(%)]

基线特征	分类	n	轻体力劳动患者(n=65)	重体力劳动患者(n=45)
年龄/岁		110	44.11±10.65^*	49.42±11.01
性别	男	72	41(63.08)	31(68.89)
	女	38	24(36.92)	14(31.11)
暴力强度	低暴力程度	29	23(35.38)^*	6(13.33)
	高暴力程度	81	42(64.62)^*	39(86.67)
术后并发症		6	3(4.62)	3(6.67)
与轻体力劳动患者比较, * P < 0.05。

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表 3 年龄和职业分组与预后质量的关联性分析

变量		OR(95%CI)	P
年龄分组	AOFAS踝-后足评分	1.090(0.312~3.816)	0.892
	二次融合	0.591(0.155~2.244)	0.439
	恢复工作时间	2.132(1.292~2.971)	< 0.001
职业分组	AOFAS踝-后足评分	0.066(0.018~0.241)	< 0.001
	二次融合	7.162(2.419, 21.200)	< 0.001
	恢复工作时间	2.434(1.818~3.049)	< 0.001

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表 4 年龄和职业对恢复工作时间影响的交互作用分析

高年龄	重体力劳动职业	OR(95%CI)	P	S (95%CI)	RERI (95%CI)	AP (95%CI)
否	否	1	-	-	-	-
是	否	19.09(7.26~50.19)	-	-	-	-
否	是	15.65(4.14~59.21)	-	-	-	-
是	是	157.6(34.38~722.55)	< 0.001	4.78(1.26~18.2)	123.87(-101.19~348.93)	0.79(0.50~1.07)
行距下融合患者采用融合前随访资料; OR为调整受伤机制后的OR值; S: 相互作用指数; RERI: 交互效应超额相对危险度; AP: 归因交互效应百分比。

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