Naumann M G, Sigurdsen U, Utvåg S E, Stavem K
Department of Orthopaedics, Østfold Hospital, Norway.
Department of Orthopaedics, Akershus University Hospital, Norway.
Injury. 2017 Jul;48(7):1662-1669. doi: 10.1016/j.injury.2017.03.039. Epub 2017 Mar 31.
To evaluate the associations of timing of surgery with postoperative length of stay (LOS), complications, and functional outcomes 3-6 years after open reduction and internal fixation (ORIF) in closed ankle fractures.
Historical cohort study by chart review of 1011 patients for postoperative LOS and complications; 959 individuals were invited to participate in a postal survey with functional outcomes questionnaires. Complications were classified as perioperative, early, or late. The associations with time from trauma to surgery (<8h, 8h to 6days, >6days) were assessed with (1) postoperative LOS using multivariable random-effects negative binomial regression, (2) complications using multivariable binary and multinomial logistic regression, and (3) three different functional outcomes using multivariable linear regression.
The mean patient age was 51.4 (range 18-94) years, 556 (55%) were female, and 567 individuals (59%) responded to the questionnaire. There were no statistically significant associations between time to surgery and either postoperative LOS or complications after adjusting for several patient and fracture characteristics. Patients operated on >6days after the trauma had significantly worse scores on the Olerud and Molander Ankle Score (OMAS) (p=0.039) and somewhat worse, but non-significant, scores on the Lower Extremity Functional Scale (LEFS; p=0.573) and the Self-Reported Foot and Ankle Score (SEFAS) scale (p=0.161) than those operated on <8h after trauma.
In ankle-fracture surgery, there was no apparent association between timing of surgery and postoperative LOS or complications. A delay of surgery for 8h to 6days resulted in similar functional outcomes after 3-6 years suggesting there may be a safe window of time for surgery of up to 6days after trauma that can be used to plan and perform the final ORIF.
评估闭合性踝关节骨折切开复位内固定术（ORIF）后手术时机与术后住院时间（LOS）、并发症及3至6年功能结局之间的关联。
通过查阅1011例患者的病历进行回顾性队列研究，以分析术后住院时间和并发症情况；邀请959名患者参与一项包含功能结局问卷的邮寄调查。并发症分为围手术期、早期或晚期。采用以下方法评估从受伤至手术时间（<8小时、8小时至6天、>6天）与各指标的关联：（1）使用多变量随机效应负二项回归分析术后住院时间；（2）使用多变量二元和多项逻辑回归分析并发症；（3）使用多变量线性回归分析三种不同的功能结局。
患者平均年龄为51.4岁（范围18 - 94岁），556例（55%）为女性，567名患者（59%）回复了问卷。在调整了多项患者和骨折特征后，手术时间与术后住院时间或并发症之间无统计学显著关联。受伤后>6天接受手术的患者，其奥勒鲁德和莫兰德踝关节评分（OMAS）显著更低（p = 0.039），下肢功能量表（LEFS；p = 0.573）和自我报告的足踝评分（SEFAS）量表评分略低但无统计学意义（p = 0.161），低于受伤后<8小时接受手术的患者。
在踝关节骨折手术中，手术时机与术后住院时间或并发症之间无明显关联。受伤后8小时至6天延迟手术，在3至6年后功能结局相似，这表明受伤后长达6天可能存在一个安全的手术时间窗，可用于规划和实施最终的切开复位内固定术。
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