Multivariable Logistic Regression Analysis Of Factors Related To Efficacy After Surgical Treatment Of Ankle Fractures

ObjectiveTo explore the risk factors affecting joint function after ankle fracture internal fixation,and provide reference for clinical prevention and treatment of dysfunction of ankle fracture and improve the quality of life of patients.MethodsA total of 311 patients with ankle fracture who underwent open reduction and internal fixation from January 2014 to December 2017 were reviewed.According to the patient' s medical record,imaging and follow-up data,factors that may affect the joint function after ankle fracture surgery were collected:age,sex,BMI index,Danish-Weber classification,Broos&Bisschop classification,smoking history,diabetes history,cause of injury,open injury,injury to operation time,fibular fracture,lower tibiofibular injury,deltoid ligament injury,medial ankle fracture,posterior ankle fracture,use of arthroscopy,operation time,removal of internal fixation,wound healing.At the last follow-up,the ankle function was evaluated according to Mazur' s ankle function scoring criteria.The patients were divided into two groups:the excellent group(Mazur<87)and the poor group(Mazur<87),and the functional evaluation group was taken as dependent variable.The factors were classified and assigned.Single factor analysis was performed for each possible influencing factor.Chi-square test or Fisher exact test were used to determine the statistical relationship between each single factor and joint function score.Then,multi factor stepwise binary logistic regression analysis was used to determine the main influencing factors.ResultsA total of 311 patients were enrolled and followed up for 13 to 49 months(average 29.6 months).The age ranged from 16 to 87 years,with an average age of 46.6±17.4 years;132 men(42.4%)and 179 women(57.6%);145 on the left side(46.6%)and 165 on the right side(53.4%);167 in the normal BMI group,108 in the reorganized BMI group and 36 in the obese group;among the causes of injury,200 people(64.3%)suffered from life sprain,24 cases(7.7%)from sports injuries,and sex intercourse.According to Broos&Bisschop classification,there were 43 single ankle,141 double ankle and 127 triple ankle,33 type A,203 type B and 75 type C according to Danish-Weber classification.At the last follow-up,Mazur ankle function score was used to evaluate the joint function:215 in the excellent group,68 in the good group,23 in the acceptable group,5 in the poor group,with an excellent and good rate of 91%;295 in the wound healing,12 in the second class,and 4 in the third class.Univariate analysis using Chi-square test or Fisher exact test found that age,diabetes history,Weber classification,medial malleolus fracture,posterior malleolus fracture,wound healing had significant differences in functional evaluation.Multivariate stepwise binary logistic regression analysis was used to analyze the factors with statistical significance.The model had statistical significance(?2=51.061,P<0.01).The variables entering the regression equation included age,Weber classification,posterior malleolus fracture and wound healing,P<0.05 had statistical significance.The final results were:age(?=0.921,P=0.009,OR=2.795,95%CI:1.301?6.006),Weber classification(?=0.877,P=0.045,OR=2.404,95%CI:1.018?5.677),posterior malleolar fracture(fracture area>25%articular surface and fixed)(p=1.764,P=0.027,OR=5.833,95%CI:1.225?27.772),wound healing(?=1.894,P=0.002,OR=6.643,95%CI:2.024?21.801),constant(p=-9.082,P<0.01),diagnostic coincidence rate:92.3%.The relationship between functional evaluation and related influencing factors of ankle fracture was:Y=-9.082+0.921X2(age)+0.877X7(Weber classification)+1.764X15(fracture area>25%articular surface and fixed)+1.894X19(wound healing).ConclusionRisk factors affecting joint function after ankle fracture were age,Weber classification,posterior malleolar fracture(fracture area>25%articular surface and fixed),and wound healing.Preoperative diagnosis combined with imaging to identify the Weber classification of ankle fracture,analysis of the effect of posterior ankle fracture on the stability of ankle joint,combined with the age of the patient to develop a personalized preoperative plan,grasp the timing of surgery,fine operation during surgery and Regular dressing and other important attention to the healing of the wound is conducive to the recovery of joint function after surgery.