Bhandari Mohit, Sprague Sheila, Hanson Beate, Busse Jason W, Dawe David E, Moro Jaydeep K, Guyatt Gordon H
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
J Orthop Trauma. 2004 Jul;18(6):338-45. doi: 10.1097/00005131-200407000-00002.
Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes.
We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals.
The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04).
As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.
尽管B型踝关节骨折通常被认为是良性的，预后良好，但观察性研究的证据表明，17%至24%的此类患者可能预后不太理想。尽管结局差异的原因尚不清楚，但先前对其他外科手术的研究表明，非手术相关原因占结局差异的很大一部分。
我们进行了一项前瞻性观察队列研究，以评估30例无其他健康问题的不稳定踝关节骨折患者的健康相关生活质量。只有来自两家大学附属医院、遭受需要手术的不稳定B型Weber损伤模式的患者符合条件。患者提供了有关饮酒、吸烟习惯和教育水平的详细基线信息。患者在定期随访时完成36项简短问卷和视觉模拟疼痛量表。
患者平均年龄为51.6岁（标准差15.2岁），57%（30例中的17例）为男性。大多数骨折是跌倒所致（67%，30例中的20例），且均为闭合性损伤。几乎一半的患者吸烟（47%，30例中的14例），而43%的患者每周饮酒（30例中的13例）。43%的患者（30例中的13例）接受的是小学或高中学历教育。患者在SF-36问卷的所有领域均有显著改善（P < 0.001），除了总体健康状况，在24个月期间基本保持正常。研究患者在8个领域中的6个领域（角色情感、社会功能、心理健康、身体疼痛、活力和总体健康）的得分与年龄匹配的美国标准数据相似。然而，患者的身体功能和角色身体得分在24个月时仍显著低于美国标准（在100分制上分别低21.8分和20.7分；P < 0.001）。吸烟史（P = 0.02）、内踝骨折的存在（P = 0.02）和较低的教育水平（P = 0.01）是术后3个月内身体功能较低的显著独立预测因素。较低的心理健康领域得分与饮酒（P = 0.02）和年龄增长（P = 0.04）显著相关。
与许多其他领域一样，社会因素可能是创伤性骨折患者结局的重要决定因素。最佳的骨科护理可能需要关注可改变的风险因素，包括吸烟和饮酒。
