The Study On Formation Factors Of Cross Healing Of Tibia And Fibula And Its Influence On The Activity Degree Of Ankle

Objective: we analyzed the clinical data of fracture of tibia?fibula and ankle retrospectively,discussing the risk factors of cross healing.study the influence of tibial and fibula interhealing on the activity degree of the patient's ankle joint by measure the activity degree of ankle joint and the functional grades of ankle joint,this study aimed to provide the theoretical basis for preventing the tibial and fibula interunion and guiding treatment.Methods and materials:A total of 196 patients were treated with open reduction and internal fixation of tibia and fibula fractures between December 2015 and June 2017 in the orthopedic section of the affiliated hospital of Yanan University.According to the results of follow-up(follow up time > 10 months)and the inclusion and exclusion criteria,the patients were divided into cross healing group and non-cross healing group(part 1),tibial and fibula cross healing group(26 cases),and no tibia and fibula cross healing group(170 cases).The observed indicators were sex,old age,history of smoking,history of drinking,history of hypertension,history of diabetes,fracture site(left or right),fixation of lower tibia and fiberhead,dislocation of tibia joint,deep drilling in surgery,and complications of postoperative incision.The results of the study were analyzed using SPSS 20.0 for single-factor statistical analysis and multiple logistic regression,using Mazui ankle scoring system,Kofoed ankle scoring system and AOFAS ankle scoring system(table)for ankle function evaluation in two groups.Ankle joint function was examined by card test.Self-control study was conducted in 26 cases of tibial and fibula cross healing for sick and healthy limb(second part).The number of back stretch and metatarsal flexion in ankle joint were measured and tested with SPSS 20.0.Results:part 1:In the single factor statistical analysis,there was a statistically significant difference in gender,fracture site,fixation of lower tibia and fibril screw,and P<0.05 with too deep drilling during surgery.The results of the multi-factor Logitic regression analysis showed that 26 patients in the cross-healing group were male and 16 men(61.5 %),17 cases(65.4 %)on the left side of the fracture site,20 cases(76.9 %)of lower tibia and fibular screws,and 17 cases were drilled deep(65.4 %)during surgery;Non-cross-healing group: 170 cases of male sex 66(38.8 %),75 cases(44.1 %)on the left side of fracture site,and 73 cases(42.9 %)of lower tibia and fibular screws.The 26 patients of the cross healing group basic data:male 16(61.5%),left fracture17(65.4 %),inferior tibialis screw20(76.9 %),and borehole depth 17(65.4 %);In the non-cross healing group,there were 170 cases:male 66(38.8 %),75 cases(44.1 %)on the left side of fracture site,73 cases(42.9 %)of inferior tibiofibular screw,and 72 cases(42.4 %)with excessive drilling depth.Male(OR=0.34,95%CI=0.14-0.84;p=0.02),fracture site(left)(OR=2.36,95%CI=0.93-5.59;P=0.07),Lower tibial screw(OR=0.22,95% CI=0.08-0.60;p =0.00),drilled too deep(OR=0.45,95% CI=0.18-1.15;p=0.10).In 72 cases(42.4 %),the drilling depth was too deep.Male(OR=0.34,95 % CI=0.14-0.84;P=0.02),fracture site(left)(OR = 2.36,95 % CI = 0.93-5.59;P = 0.07),lower tibia screw fixation(OR = 0.22,95 % CI=0.08-0.60;P=0.00),Deep drilling during surgery(OR=0.45,95% CI=0.18-1.15;P=0.10).The results showed that lower tibia and fibular screw fixation was an independent risk factor for tibia and fibular cross healing(P<0.05).the Kofoed ankle scoring system: the cross healing group 18 cases were excellent(85-100),8 cases were good(75-85),0 cases were level(70-74)and 0 cases were poor(<70),there were 102 cases of excellent(85-100),68 cases of good(75-85),6 cases of level(70-74),0 cases of poor(< 70)in non-cross healing group,P value > 0.05;AOFAS ankle scoring system: 15 cases of excellent(90-100),6 cases of good(75-89),5 cases of median(50-74)and 0 cases of poor(<50)in cross healing group;There were 94 cases of excellent(90-100),43 cases of good(75-89),33 cases of middle(50-74),0 cases of poor(< 50)in the non-cross healing group,P value > 0.05.there are no statistical significance.Part 2:The 26 patients in the experimental group with posterior extensional angle 12.77+2.14 degrees,and the control group with 20.81+10.2 degrees;The ankle metatarsal flexion was 45.73+2.13 degrees in the experimental group and 49.54 + 1.39 degrees in the control group.In the experimental group,the mean backstretch angle was 8.03 degrees lower than in the control group,and the mean metatarsal flexion angle was 3.81 degrees lower than in the control group.There were statistical differences between the two groups.Conclusion: The gender male and lower tibia fibula screws are risk factors for cross healing.The ankle activity will be lost in patients with tibia-fibula cross healing,but there is no significant difference in function compared with non-cross healing patients.