[1]陈卫东,余春华,梁林,等.血浆纤维蛋白原水平和血沉对踝关节骨折内固定术后预后的预测价值[J].中医正骨,2023,35(11):14-17,43.
　CHEN Weidong,YU Chunhua,LIANG Lin,et al.The values of plasma fibrinogen level and erythrocyte sedimentation rate in predicting prognosis after internal fixation for ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):14-17,43.
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血浆纤维蛋白原水平和血沉对踝关节骨折内固定术后预后的预测价值()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年11期
页码:
14-17,43
栏目:
临床研究
出版日期:
2023-11-20

文章信息/Info

Title:
The values of plasma fibrinogen level and erythrocyte sedimentation rate in predicting prognosis after internal fixation for ankle fractures
作者:
陈卫东; 余春华; 梁林; 杜俊锋
绍兴市上虞人民医院,浙江 绍兴 312399
Author(s):
CHEN Weidong; YU Chunhua; LIANG Lin; DU Junfeng
Shaoxing Shangyu People's Hospital,Shaoxing 312399,Zhejiang,China
关键词:
踝部骨折;  骨折固定术; 内;  预后;  纤维蛋白原;  血沉
Keywords:
ankle fractures;  fracture fixation; internal;  prognosis;  fibrinogen;  blood sedimentation
摘要:
目的:探讨血浆纤维蛋白原(fibrinogen,FIB)水平和血沉对踝关节骨折内固定术后预后的预测价值。方法:以接受同一组医生完成的切开复位钢板内固定手术治疗的单侧创伤性踝关节骨折患者为研究对象。收集患者的性别、年龄、体质量指数、致伤原因、骨折AO分型、跟骨牵引情况及合并高血压、糖尿病等资料。术后1周,采集患者的外周静脉血,检测血浆FIB水平和血沉。随访观察患侧踝关节功能恢复情况,依据美国足与踝关节协会踝与后足评分标准对患侧踝关节进行评分,得分≥75分记为预后良好,<75分记为预后不良。根据术后6个月时患侧踝关节评分将纳入的患者分为预后良好组和预后不良组。比较2组患者一般资料和术后1周时的血浆FIB水平及血沉,分析影响踝关节骨折内固定术后预后的因素,评价血浆FIB水平和血沉对踝关节骨折内固定术后预后不良的预测价值。结果:①一般结果。共纳入100例患者,预后良好组84例、预后不良组16例。预后不良组患者年龄较预后良好组大[(53.94±7.15)岁,(48.43±7.02)岁,t=2.869,P=0.005],骨折AO分型B型、C型占比较预后良好组高(χ2=15.143,P=0.001)。②血浆FIB水平和血沉检测结果。术后1周时,预后不良组血浆FIB水平较预后良好组高[(4.52±1.27)g·L-1,(3.71±1.05)g·L-1,t=2.733,P=0.007],血沉较预后良好组快[(37.82±5.13)mm·h-1,(32.34±4.59)mm·h-1,t=4.374,P=0.001]。③踝关节骨折内固定术后预后不良的影响因素分析结果。年龄、骨折AO分型、血浆FIB水平、血沉均是踝关节骨折术后预后不良的影响因素(β=1.343,P=0.003,OR=3.831; β=1.379,P=0.002,OR=3.971; β=1.543,P=0.003,OR=4.679; β=1.437,P=0.002,OR=4.208)。④血浆FIB水平和血沉对踝关节骨折内固定术后预后不良的预测价值评价结果。术后1周时血浆FIB水平、血沉分别预测及二者联合预测踝关节骨折内固定术后预后不良的受试者操作特征曲线下面积分别为0.694(P=0.001)、0.708(P=0.001)、0.823(P=0.000),灵敏度分别为62.50%、71.88%、84.37%,特异度分别为70.24%、61.90%、76.19%,2项指标的临界值分别为4.11 g·L-1、35.08 mm·h-1。结论:术后1周时血浆FIB水平和血沉对踝关节骨折内固定术后预后不良具有一定的预测价值,二者联合检测的预测价值更高。
Abstract:
Objective:To explore the values of plasma fibrinogen(FIB)level and erythrocyte sedimentation rate(ESR)in predicting prognosis after internal fixation for treatment of ankle fractures.Methods:The patients who underwent open reduction and steel plate internal fixation for treatment of unilateral traumatic ankle fractures by the same surgeons were selected as the subjects,and their information including gender,age,body mass index,cause of injury,AO fracture classification,calcaneus traction,whether combined with hypertension and whether combined with diabetes was collected.At postoperative week 1,the blood was drawn from the peripheral vein,and the plasma FIB level and ESR were detected.The patients were followed up and the ankle function recovery of the affected side was observed.The affected ankle was scored according to the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hind scoring criteria,and the prognosis was evaluated based on the scores.The score of≥75 points was classified as favorable prognosis,while the score of<75 points as unfavorable prognosis.According to the score of affected ankle evaluated at postsurgical month 6,the included patients were divided into favorable prognosis group and unfavorable prognosis group.The general data of patients and the plasma FIB level and ESR detected at postoperative week 1 were compared between the 2 groups.The factors influencing prognosis after internal fixation for ankle fractures were analyzed,and the values of plasma FIB level and ESR in predicting unfavorable prognosis was evaluated.Results:①One hundred patients were enrolled in the study,84 ones in favorable prognosis group and 16 ones in unfavorable prognosis group.The patients were elder in unfavorable prognosis group compared to favorable prognosis group(53.94±7.15 vs 48.43±7.02 years,t=2.869,P=0.005),and the type B and C ankle fractures accounted for a higher proportion in unfavorable prognosis group compared with that of favorable prognosis group(χ2=15.143,P=0.001).②At postoperative week 1,the plasma FIB level was higher,and the ESR was faster in unfavorable prognosis group compared to favorable prognosis group(4.52±1.27 vs 3.71±1.05 g/L,t=2.733,P=0.007; 37.82±5.13 vs 32.34±4.59 mm/h,t=4.374,P=0.001).③The age,AO fracture classification,plasma FIB level and ESR were the factors influencing unfavorable prognosis after internal fixation for ankle fractures(β=1.343,P=0.003,OR=3.831; β=1.379,P=0.002,OR=3.971; β=1.543,P=0.003,OR=4.679; β=1.437,P=0.002,OR=4.208).④The applied values of plasma FIB level and ESR detected at postsurgical week 1 in individual prediction or unified prediction of unfavorable prognosis after internal fixation for ankle fractures was evaluated and analyzed by using receiver operating characteristic(ROC)curve; and the results showed that the areas under the ROC curves were 0.694(P=0.001),0.708(P=0.001)and 0.823(P=0.000); the sensitivities were 62.50%,71.88% and 84.37%; and the specificities were 70.24%,61.90% and 76.19% respectively; moreover,the critical values of the two indexes were 4.11 g/L and 35.08 mm/h respectively.Conclusion:The plasma FIB level and ESR detected at postsurgical week 1 have a certain application value in prediction of unfavorable prognosis after internal fixation for ankle fractures,and the unification of the two indexes displays a more higher application value.

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备注/Memo:
通讯作者:杜俊锋 E-mail:du_junfeng@126.com
更新日期/Last Update: 1900-01-01