Hu Xin, Wang Peiyuan, Li Chengsi, Liu Lin, Wang Xin, Jin Lin, Zhao Kuo, Wang Ling, Hou Zhiyong
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
Int Orthop. 2025 Feb;49(2):503-513. doi: 10.1007/s00264-024-06402-2. Epub 2025 Jan 8.
High Fascial Compartment Pressure (HCP) is one of the most common complications in ankle fractures. This study aimed to investigate the incidence of HCP in pilon fracture and analyze the risk factors of HCP in order to closely monitor its further development into Acute Compartment Syndrome. A nomogram is constructed and validated to predict HCP in patients with pilon fracture.
We collected information on 1,863 patients with pilon fracture in the 3rd Hospital of Hebei Medical University Hospital from January 2019 to March 2024. Patients with HCP were assigned to the HCP group and those without HCP to the non-HCP group. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury types, and laboratory biomarkers. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with HCP. The selected predictors were then entered into R software for further analysis, and Nomogram construction.
The rate of HCP was 11.57%. Several predictors of HCP were found, including Body Mass Index (BMI) (p<0.001), Deep Vein Thrombosis (p < 0.001), occurrence of Fracture Blister (FB) (p < 0.001), use of Dehydrating Agent (p < 0.001), duration of limb immobilization (p < 0.001),and Systemic Immune-inflammation Index (SII) (p < 0.001). In addition, BMI (p < 0.001, OR 1.52, 95% CI 1.35 to 1.71), DVT (p < 0.001, OR 4.35, 95% CI 2.51 to 7.52), duration of limb immobilization (p < 0.01, OR 1.66, 95%CI 1.25 to 2.20) and SII (p < 0.01, OR 1.00, 95%CI 1.00 to 1.00) were correlated with increased HCP risk. Meanwhile, FB (p < 0.001, OR 0.23, 95% CI 0.13 to 0.39) and Dehydrating Agent (p < 0.001, OR 0.10, 95% CI 0.06 to 0.19) were associated with decreased HCP risk. The nomogram was established based on six predictors independently related to HCP.
Our investigation has shown that, compared with tibial diaphyseal fractures, pilon fractures are more prone to HCP because of their high energy injury characteristics. This research also shows BMI, DVT, occurrence of FB, use of Dehydrating Agent, duration of limb immobilization, and SII are independent risk factors for HCP in patients with pilon fracture. We have also devised a nomogram grounded in these identified predictors. In particular, this study found for the first time that SII is an independent risk factor for HCP, which provides a basis for clinical and basic science research on fascial immunology in the future.
高筋膜室压力（HCP）是踝关节骨折最常见的并发症之一。本研究旨在调查pilon骨折中HCP的发生率，并分析HCP的危险因素，以便密切监测其进一步发展为急性筋膜室综合征的情况。构建并验证了一种列线图，用于预测pilon骨折患者的HCP。
我们收集了2019年1月至2024年3月在河北医科大学第三医院的1863例pilon骨折患者的信息。有HCP的患者被分配到HCP组，无HCP的患者被分配到非HCP组。通过查询住院病历系统进行数据收集，包括人口统计学、合并症、损伤类型和实验室生物标志物。单因素分析中显著性水平P<0.05的变量纳入多因素logistic回归分析。应用向后逐步回归方法确定与HCP相关的独立危险因素。然后将选定的预测因素输入R软件进行进一步分析和列线图构建。
HCP发生率为11.57%。发现了几个HCP的预测因素，包括体重指数（BMI）（p<0.001）、深静脉血栓形成（p<0.001）、骨折水疱（FB）的发生（p<0.001）、脱水剂的使用（p<0.001）、肢体固定时间（p<0.001）和全身免疫炎症指数（SII）（p<0.001）。此外，BMI（p<0.001，OR 1.52，95%CI 1.35至1.71）、DVT（p<0.001，OR 4.35，95%CI 2.51至7.52）、肢体固定时间（p<0.01，OR 1.66，95%CI 1.25至2.20）和SII（p<0.01，OR 1.00，95%CI 1.00至）与HCP风险增加相关。同时，FB（p<0.001，OR 0.23，95%CI 0.13至0.39）和脱水剂（p<0.001，OR 0.10，95%CI 0.06至0.19）与HCP风险降低相关。基于与HCP独立相关的六个预测因素建立了列线图。
我们的调查表明，与胫骨干骨折相比，pilon骨折由于其高能量损伤特征更容易发生HCP。本研究还表明，BMI、DVT、FB的发生、脱水剂的使用、肢体固定时间和SII是pilon骨折患者发生HCP的独立危险因素。我们还根据这些确定的预测因素设计了一种列线图。特别是，本研究首次发现SII是HCP的独立危险因素，为未来筋膜免疫学的临床和基础科学研究提供了依据。
