Masrouha Karim Z, Tamim Hani, Taha Assad, Sheikh Taha Abdel Majid, Abi-Melhem Racha, Al-Taki Muhyeddine
Chief Orthopaedic Resident, Division of Orthopaedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Associate Professor of Medicine, Director of the Biostatistics Unit, Clinical Research Unit, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
J Foot Ankle Surg. 2017 Mar-Apr;56(2):332-335. doi: 10.1053/j.jfas.2016.09.011. Epub 2016 Dec 29.
Ankle fractures requiring open reduction and internal fixation vary in severity from unimalleolar fractures to bimalleolar/trimalleolar (BT) fractures to pilon fractures. Consequently, the postoperative outcomes with these surgeries can vary. Most previous studies of these injuries had small sample sizes, studied a single risk factor or adverse event, or did not compare different injuries by severity. The purpose of the present study was to describe and compare the patient characteristics and postoperative outcomes of 2 high-energy ankle fractures: BT and pilon fractures. The relevant patients were identified from the American College of Surgeons National Surgical Quality Improvement Program database using the Current Procedural Terminology codes for BT and pilon fractures. Patient demographics, characteristics, comorbidities, and 30-day mortality and adverse events were recorded and compared between the 2 types of ankle fractures. More than 45% of patients with these fracture types were aged 40 to 65 years. Pilon fractures occurred more frequently in younger patients, were more likely to occur in men, required a longer hospital stay and operative time, were less likely to occur in patients with a body mass index of >30 kg/m, and conferred a greater risk of wound complications (odds ratio 1.76; p = .048) compared with BT fractures. The findings from the present study help us understand the differences in patient characteristics and potential early adverse events after open reduction and internal fixation of BT fractures versus pilon fractures.
需要切开复位内固定的踝关节骨折严重程度各异，从单踝骨折到双踝/三踝（BT）骨折，再到Pilon骨折。因此，这些手术的术后结果可能有所不同。此前关于这些损伤的大多数研究样本量较小，研究单一风险因素或不良事件，或者未按严重程度比较不同损伤。本研究的目的是描述和比较两种高能踝关节骨折（BT骨折和Pilon骨折）的患者特征及术后结果。使用BT骨折和Pilon骨折的现行手术操作术语编码，从美国外科医师学会国家外科质量改进计划数据库中识别相关患者。记录并比较两种类型踝关节骨折患者的人口统计学特征、特点、合并症、30天死亡率及不良事件。这些骨折类型的患者中超过45%年龄在40至65岁之间。与BT骨折相比，Pilon骨折在年轻患者中更常见，更易发生于男性，住院时间和手术时间更长，体重指数>30kg/m²的患者中较少发生，且伤口并发症风险更高（优势比1.76；P = 0.048）。本研究结果有助于我们了解BT骨折与Pilon骨折切开复位内固定术后患者特征及潜在早期不良事件的差异。
