Egol Kenneth A, Tejwani Nirmal C, Walsh Michael G, Capla Edward L, Koval Kenneth J
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
J Bone Joint Surg Am. 2006 May;88(5):974-9. doi: 10.2106/JBJS.E.00343.
Ankle fractures are among the most common injuries treated by orthopaedic surgeons. However, very few investigators have examined the functional recovery following ankle fracture surgery and, to our knowledge, none have analyzed factors that may predict functional recovery. In this study, we evaluated predictors of short-term functional outcome following surgical stabilization of ankle fractures.
Over three years, 232 patients who sustained a fracture of the ankle and were treated surgically were followed prospectively, for a minimum of one year. Trained interviewers recorded baseline characteristics, including patient demographics, medical comorbidities, and functional status according to the Short Musculoskeletal Function Assessment (SMFA). Laboratory findings, the American Society of Anesthesiologists (ASA) class, and operative findings were recorded from the chart during hospitalization. Follow-up information included the occurrence of complications or additional surgery, weight-bearing status, functional status according to the SMFA, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The data were analyzed to determine predictors of functional recovery at three months, six months, and one year postoperatively.
Complete follow-up data were available for 198 patients (85%). At one year, 174 (88%) of the patients had either no or mild ankle pain and 178 (90%) had either no limitations or limitations only in recreational activities. According to the AOFAS ankle-hindfoot score, 178 (90%) of the patients had > or = 90% functional recovery. A patient age of less than forty years was a predictor of recovery, as measured with the SMFA subscores, at six months after the ankle fracture. At one year, however, age was no longer a predictor of recovery. Patients who were younger than forty were more likely to recover > or = 90% of function (p = 0.004), and men were more likely than women to recover function (p = 0.02). ASA Class 1 or 2 (p = 0.03) and an absence of diabetes (p = 0.02) were also predictors of better functional recovery at one year. SMFA subscores were below average at baseline, indicating a healthy population. At three and six months postoperatively, all SMFA subscores were significantly higher than the baseline subscores (p < 0.001); however, at one year, the SMFA subscores were almost back to the baseline, normal level.
One year after ankle fracture surgery, patients are generally doing well, with most experiencing little or mild pain and few restrictions in functional activities. They have a significant improvement in function compared with six months after the surgery. Younger age, male sex, absence of diabetes, and a lower ASA class are predictive of functional recovery at one year following ankle fracture surgery. It is important to counsel patients and their families regarding the expected functional recovery after an ankle injury.
踝关节骨折是骨科医生治疗的最常见损伤之一。然而，很少有研究者研究踝关节骨折手术后的功能恢复情况，据我们所知，没有人分析过可能预测功能恢复的因素。在本研究中，我们评估了踝关节骨折手术稳定后短期功能结局的预测因素。
在三年多的时间里，对232例踝关节骨折并接受手术治疗的患者进行了前瞻性随访，随访时间至少为一年。训练有素的访员记录基线特征，包括患者人口统计学资料、合并症以及根据简短肌肉骨骼功能评估（SMFA）得出的功能状态。住院期间从病历中记录实验室检查结果、美国麻醉医师协会（ASA）分级和手术结果。随访信息包括并发症或再次手术的发生情况、负重状态、根据SMFA得出的功能状态以及美国矫形足踝协会（AOFAS）踝后足评分。对数据进行分析，以确定术后三个月、六个月和一年时功能恢复的预测因素。
198例患者（85%）获得了完整的随访数据。一年时，174例（88%）患者无踝关节疼痛或仅有轻微疼痛，178例（90%）患者无功能受限或仅在娱乐活动中有受限。根据AOFAS踝后足评分，178例（90%）患者功能恢复≥90%。踝关节骨折后六个月时，年龄小于40岁的患者是功能恢复的预测因素，这是根据SMFA子评分得出的。然而，在一年时，年龄不再是功能恢复的预测因素。年龄小于40岁的患者更有可能恢复≥90%的功能（p = 0.004），男性比女性更有可能恢复功能（p = 0.02）。ASA分级为1或2级（p = 0.03）以及无糖尿病（p = 0.02）也是一年时功能恢复较好的预测因素。SMFA子评分在基线时低于平均水平，表明研究人群健康。术后三个月和六个月时，所有SMFA子评分均显著高于基线子评分（p < 0.001）；然而，在一年时，SMFA子评分几乎恢复到基线正常水平。
踝关节骨折手术后一年，患者总体情况良好，大多数患者疼痛轻微或无疼痛，功能活动受限较少。与术后六个月相比，他们的功能有显著改善。年龄较小、男性、无糖尿病以及较低的ASA分级是踝关节骨折手术后一年功能恢复的预测因素。向患者及其家属提供有关踝关节损伤后预期功能恢复的咨询很重要。
