Analysis of incidence and related factors of postoperative complications of Pilon fracture
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摘要:
目的 分析Pilon骨折术后并发症的发生情况与影响因素，为临床防治Pilon骨折术后并发症提供参考依据。 方法 将2017年1月—2022年2月中国人民武装警察部队海警总队医院骨四科收治的126例Pilon骨折患者纳入研究；根据是否发生并发症将患者分为并发症组(38例)与非并发症组(88例)，比较2组患者相关资料(性别、年龄、吸烟、糖尿病史、高血压史、骨折类型、骨折分型、合并腓骨骨折、骨折复位效果、植骨)，再运用logistic回归分析研究发生并发症的影响因素。 结果 所有患者均随访6个月，骨折愈合良好119例(94.44%)，骨折延迟愈合或不愈合7例(5.56%)；发生并发症38例，发生率为30.16%，均予以对症处理，处理后愈合。并发症组与非并发症组的骨折类型、骨折分型、是否合并腓骨骨折、骨折复位效果、是否植骨比较差异有统计学意义(均P < 0.05)；多因素logistic回归分析结果显示，闭合性骨折、骨折分型Ⅱ型、骨折复位效果良好是Pilon骨折术后并发症的保护因素，合并腓骨骨折、植骨是Pilon骨折术后发生并发症的危险因素。 结论 Pilon骨折术后并发症的发生率较高，合并腓骨骨折、植骨是其危险因素，应严格进行术前评估，术中、术后积极预防并发症，以促进患者尽快康复。 Abstract:Objective To analyze the incidence and influencing factors of postoperative complications of Pilon fracture, and provide reference basis for clinical prevention and treatment of postoperative complications of Pilon fracture. Methods A total of 126 patients with Pilon fracture who were admitted to the Fourth Department of Osteology of the Marine Police Corps Hospital of the Chinese People ' s Armed Police Force from January 2017 to February 2022 were included in the study. The patients were divided into complication group (38 cases) and non-complication group (88 cases) according to whether there were complications. The relevant data (gender, age, smoking, history of diabetes, history of hypertension, fracture type, fracture classification, combined fibular fracture, fracture reduction effect, bone graft) between the two groups was compared, and then the influencing factors of complications were analyzed by Logistic analysis. Results All patients were followed up for 6 months, 119 cases (94.44%) had good fracture healing, 7 cases (5.56%) had delayed or nonunion fracture healing. Complications occurred in 38 cases (30.16%), which were treated symptomatically and healed after treatment. There was significant difference in fracture type, fracture classification, combined fibular fracture, fracture reduction effect and bone graft between the complication group and the non-complication group (P < 0.05). Multivariate logistic regression analysis results showed that fracture type (closed), fracture classification (type Ⅱ), and fracture reduction effect (good) were protective factors for postoperative complications of Pilon fracture, fibular fracture and bone graft were risk factors for postoperative complications of Pilon fracture. Conclusion The incidence of postoperative complications of Pilon fracture is high. The risk factors of Pilon fracture are fibular fracture and bone graft. Preoperative evaluation should be strictly carried out, and complications should be actively prevented during and after the operation to promote the recovery of patients as soon as possible. -
Key words:
- Pilon fracture /
- Complication /
- Incidence rate /
- Related factors
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表 1 2组Pilon骨折患者相关资料比较
Table 1. Comparison of relevant data between the two groups of Pilon fracture patients
项目 例数 并发症组
(38例)非并发症组
(88例)统计量 P值 性别[例(%)] 男性 98 30(30.61) 68(69.39) 0.043a 0.836 女性 28 8(28.57) 20(71.43) 年龄(x±s，岁) 41.95±6.25 41.39±6.31 0.458b 0.645 吸烟[例(%)] 有 57 18(31.58) 39(68.42) 0.100a 0.752 无 69 20(28.99) 49(71.01) 糖尿病史[例(%)] 有 7 2(28.57) 5(71.43) 0.009a 0.925 无 119 36(30.25) 83(69.75) 高血压史[例(%)] 有 10 4(40.00) 6(60.00) 0.499a 0.480 无 116 34(29.31) 82(70.69) 骨折类型[例(%)] 闭合性 110 37(33.64) 73(66.36) 4.974a 0.026 开放性 16 1(6.25) 15(93.75) 骨折分型[例(%)] Ⅱ型 59 9(15.25) 50(84.75) 23.061a ＜0.001 Ⅲ型 67 29(43.28) 38(56.72) 合并腓骨骨折[例(%)] 是 88 32(36.36) 56(63.64) 5.334a 0.021 否 38 6(15.79) 32(84.21) 骨折复位效果[例(%)] 良好 112 31(27.68) 81(72.32) 12.571c ＜0.001 一般 10 4(40.00) 6(60.00) 差 4 3(75.00) 1(25.00) 植骨[例(%)] 是 75 28(37.33) 47(62.67) 4.528a 0.033 否 51 10(19.61) 41(80.39) 注：a为χ2值，b为t值，c为Z值。 
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表 2 变量赋值方法
Table 2. Variable assignment methods
变量 赋值方法 骨折类型 1=闭合性；2=开放性 骨折分型 1=Ⅱ型；2=Ⅲ型 合并腓骨骨折 1=是；2=否 骨折复位效果 1=良好；2=一般、差 植骨 1=是；2=否
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表 3 Pilon骨折术后并发症的logistic回归分析
Table 3. logistic regression analysis of postoperative complications of Pilon fractures
变量 B SE Wald χ2 P值 OR值 95% CI 闭合性骨折 -1.323 0.441 9.000 0.003 0.266 0.112~0.632 Ⅱ型骨折 -4.265 0.726 34.512 < 0.001 0.014 1.358~5.757 合并腓骨骨折 0.662 0.287 5.320 0.021 1.939 1.104~3.402 骨折复位良好 -0.843 0.233 13.090 < 0.001 0.430 0.273~0.680 植骨 2.321 0.461 25.348 < 0.001 10.186 4.127~25.143
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