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[1]陳衛(wèi)東,余春華,梁林,等.血漿纖維蛋白原水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后的預(yù)測(cè)價(jià)值[J].中醫(yī)正骨,2023,35(11):14-17,43.
　CHEN Weidong,YU Chunhua,LIANG Lin,et al.The values of plasma fibrinogen level and erythrocyte sedimentation rate in predicting prognosis after internal fixation for ankle fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(11):14-17,43.
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血漿纖維蛋白原水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后的預(yù)測(cè)價(jià)值()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年11期
頁(yè)碼:
14-17,43
欄目:
臨床研究
出版日期:
2023-11-20

文章信息/Info

Title:
The values of plasma fibrinogen level and erythrocyte sedimentation rate in predicting prognosis after internal fixation for ankle fractures
作者:
陳衛(wèi)東; 余春華; 梁林; 杜俊鋒
紹興市上虞人民醫(yī)院,浙江 紹興 312399
Author(s):
CHEN Weidong; YU Chunhua; LIANG Lin; DU Junfeng
Shaoxing Shangyu People's Hospital,Shaoxing 312399,Zhejiang,China
關(guān)鍵詞:
踝部骨折;  骨折固定術(shù); 內(nèi);  預(yù)后;  纖維蛋白原;  血沉
Keywords:
ankle fractures;  fracture fixation; internal;  prognosis;  fibrinogen;  blood sedimentation
摘要:
目的:探討血漿纖維蛋白原(fibrinogen,FIB)水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后的預(yù)測(cè)價(jià)值。方法:以接受同一組醫(yī)生完成的切開復(fù)位鋼板內(nèi)固定手術(shù)治療的單側(cè)創(chuàng)傷性踝關(guān)節(jié)骨折患者為研究對(duì)象。收集患者的性別、年齡、體質(zhì)量指數(shù)、致傷原因、骨折AO分型、跟骨牽引情況及合并高血壓、糖尿病等資料。術(shù)后1周,采集患者的外周靜脈血,檢測(cè)血漿FIB水平和血沉。隨訪觀察患側(cè)踝關(guān)節(jié)功能恢復(fù)情況,依據(jù)美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)踝與后足評(píng)分標(biāo)準(zhǔn)對(duì)患側(cè)踝關(guān)節(jié)進(jìn)行評(píng)分,得分≥75分記為預(yù)后良好,<75分記為預(yù)后不良。根據(jù)術(shù)后6個(gè)月時(shí)患側(cè)踝關(guān)節(jié)評(píng)分將納入的患者分為預(yù)后良好組和預(yù)后不良組。比較2組患者一般資料和術(shù)后1周時(shí)的血漿FIB水平及血沉,分析影響踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后的因素,評(píng)價(jià)血漿FIB水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后不良的預(yù)測(cè)價(jià)值。結(jié)果:①一般結(jié)果。共納入100例患者,預(yù)后良好組84例、預(yù)后不良組16例。預(yù)后不良組患者年齡較預(yù)后良好組大[(53.94±7.15)歲,(48.43±7.02)歲,t=2.869,P=0.005],骨折AO分型B型、C型占比較預(yù)后良好組高(χ2=15.143,P=0.001)。②血漿FIB水平和血沉檢測(cè)結(jié)果。術(shù)后1周時(shí),預(yù)后不良組血漿FIB水平較預(yù)后良好組高[(4.52±1.27)g·L-1,(3.71±1.05)g·L-1,t=2.733,P=0.007],血沉較預(yù)后良好組快[(37.82±5.13)mm·h-1,(32.34±4.59)mm·h-1,t=4.374,P=0.001]。③踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后不良的影響因素分析結(jié)果。年齡、骨折AO分型、血漿FIB水平、血沉均是踝關(guān)節(jié)骨折術(shù)后預(yù)后不良的影響因素(β=1.343,P=0.003,OR=3.831; β=1.379,P=0.002,OR=3.971; β=1.543,P=0.003,OR=4.679; β=1.437,P=0.002,OR=4.208)。④血漿FIB水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后不良的預(yù)測(cè)價(jià)值評(píng)價(jià)結(jié)果。術(shù)后1周時(shí)血漿FIB水平、血沉分別預(yù)測(cè)及二者聯(lián)合預(yù)測(cè)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后不良的受試者操作特征曲線下面積分別為0.694(P=0.001)、0.708(P=0.001)、0.823(P=0.000),靈敏度分別為62.50%、71.88%、84.37%,特異度分別為70.24%、61.90%、76.19%,2項(xiàng)指標(biāo)的臨界值分別為4.11 g·L-1、35.08 mm·h-1。結(jié)論:術(shù)后1周時(shí)血漿FIB水平和血沉對(duì)踝關(guān)節(jié)骨折內(nèi)固定術(shù)后預(yù)后不良具有一定的預(yù)測(cè)價(jià)值,二者聯(lián)合檢測(cè)的預(yù)測(cè)價(jià)值更高。
Abstract:
Objective:To explore the values of plasma fibrinogen(FIB)level and erythrocyte sedimentation rate(ESR)in predicting prognosis after internal fixation for treatment of ankle fractures.Methods:The patients who underwent open reduction and steel plate internal fixation for treatment of unilateral traumatic ankle fractures by the same surgeons were selected as the subjects,and their information including gender,age,body mass index,cause of injury,AO fracture classification,calcaneus traction,whether combined with hypertension and whether combined with diabetes was collected.At postoperative week 1,the blood was drawn from the peripheral vein,and the plasma FIB level and ESR were detected.The patients were followed up and the ankle function recovery of the affected side was observed.The affected ankle was scored according to the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hind scoring criteria,and the prognosis was evaluated based on the scores.The score of≥75 points was classified as favorable prognosis,while the score of<75 points as unfavorable prognosis.According to the score of affected ankle evaluated at postsurgical month 6,the included patients were divided into favorable prognosis group and unfavorable prognosis group.The general data of patients and the plasma FIB level and ESR detected at postoperative week 1 were compared between the 2 groups.The factors influencing prognosis after internal fixation for ankle fractures were analyzed,and the values of plasma FIB level and ESR in predicting unfavorable prognosis was evaluated.Results:①One hundred patients were enrolled in the study,84 ones in favorable prognosis group and 16 ones in unfavorable prognosis group.The patients were elder in unfavorable prognosis group compared to favorable prognosis group(53.94±7.15 vs 48.43±7.02 years,t=2.869,P=0.005),and the type B and C ankle fractures accounted for a higher proportion in unfavorable prognosis group compared with that of favorable prognosis group(χ2=15.143,P=0.001).②At postoperative week 1,the plasma FIB level was higher,and the ESR was faster in unfavorable prognosis group compared to favorable prognosis group(4.52±1.27 vs 3.71±1.05 g/L,t=2.733,P=0.007; 37.82±5.13 vs 32.34±4.59 mm/h,t=4.374,P=0.001).③The age,AO fracture classification,plasma FIB level and ESR were the factors influencing unfavorable prognosis after internal fixation for ankle fractures(β=1.343,P=0.003,OR=3.831; β=1.379,P=0.002,OR=3.971; β=1.543,P=0.003,OR=4.679; β=1.437,P=0.002,OR=4.208).④The applied values of plasma FIB level and ESR detected at postsurgical week 1 in individual prediction or unified prediction of unfavorable prognosis after internal fixation for ankle fractures was evaluated and analyzed by using receiver operating characteristic(ROC)curve; and the results showed that the areas under the ROC curves were 0.694(P=0.001),0.708(P=0.001)and 0.823(P=0.000); the sensitivities were 62.50%,71.88% and 84.37%; and the specificities were 70.24%,61.90% and 76.19% respectively; moreover,the critical values of the two indexes were 4.11 g/L and 35.08 mm/h respectively.Conclusion:The plasma FIB level and ESR detected at postsurgical week 1 have a certain application value in prediction of unfavorable prognosis after internal fixation for ankle fractures,and the unification of the two indexes displays a more higher application value.

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