功能结果
很大一批患者仍会抱怨有僵硬(一项研究报道高达63%)、疼痛和肿胀等不适,骨折类型间有一定的差异。[39]Hancock MJ, Herbert RD, Stewart M. Prediction of outcome after ankle fracture. J Orthop Sports Phys Ther. 2005;35:786-792.http://www.ncbi.nlm.nih.gov/pubmed/16848099?tool=bestpractice.com[40]Shah NH, Sundaram RO, Velusamy A, et al. Five-year functional outcome analysis of ankle fracture fixation. Injury. 2007;38:1308-1312.http://www.ncbi.nlm.nih.gov/pubmed/17888434?tool=bestpractice.com
短的肌肉骨骼系统功能评估/美国足踝外科学会足踝评分
使用短的肌肉骨骼系统功能评估和美国足踝外科学会足踝评分,1年时手术治疗的双踝骨折患者比手术治疗的外踝骨折和内侧三角韧带损伤患者功能更差。[41]Tejwani NC, McLaurin TM, Walsh M, et al. Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury? J Bone Joint Surg Am. 2007;89:1438-1441.http://www.ncbi.nlm.nih.gov/pubmed/17606780?tool=bestpractice.com同样,据报道,年纪轻、男性和无糖尿病的患者踝关节骨折手术固定后1年时的功能恢复更好。[42]Egol KA, Tejwani NC, Walsh MG, et al. Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am. 2006;88:974-979.http://www.ncbi.nlm.nih.gov/pubmed/16651571?tool=bestpractice.com同样还有以下一种趋势:踝关节骨折手术固定后早期功能康复的患者,功能恢复更早。[22]Petrisor BA, Poolman R, Koval K, et al. Management of displaced ankle fractures. J Orthop Trauma. 2006;20:515-518.http://www.ncbi.nlm.nih.gov/pubmed/16891946?tool=bestpractice.com[43]Dehghan N, McKee MD, Jenkinson RJ, et al. Early weightbearing and range of motion versus non-weightbearing and immobilization after open reduction and internal fixation of unstable ankle fractures: a randomized controlled trial. J Orthop Trauma. 2016;30:345-352.http://www.ncbi.nlm.nih.gov/pubmed/27045369?tool=bestpractice.com
根据短的肌肉骨骼系统功能评分问卷调查,下胫腓损伤手术治疗的患者对下胫腓解剖复位后功能恢复更好。[6]Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. 2005;19:102-108.http://www.ncbi.nlm.nih.gov/pubmed/15677926?tool=bestpractice.com
SF-36评分
踝关节不稳定骨折手术治疗的患者中,根据SF-36功能结果评分,受伤后2年时健康状况仍有持续改善。[44]Bhandari M, Sprague S, Hanson B, et al. Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study. J Orthop Trauma. 2004;18:338-345.http://www.ncbi.nlm.nih.gov/pubmed/15213498?tool=bestpractice.com[45]Obremskey WT, Dirschl DR, Crowther JD, et al. Change over time of SF-36 functional outcomes for operatively treated unstable ankle fractures. J Orthop Trauma. 2002;16:30-33.http://www.ncbi.nlm.nih.gov/pubmed/11782630?tool=bestpractice.com[46]Nilsson G, Jonsson K, Ekdahl C, et al. Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older. BMC Musculoskelet Disord. 2007;8:127.http://www.biomedcentral.com/1471-2474/8/127http://www.ncbi.nlm.nih.gov/pubmed/18096062?tool=bestpractice.com但是,2年时SF-36中的身体功能评分仍低于正常人群。[44]Bhandari M, Sprague S, Hanson B, et al. Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study. J Orthop Trauma. 2004;18:338-345.http://www.ncbi.nlm.nih.gov/pubmed/15213498?tool=bestpractice.com研究发现,吸烟、教育程度低和有内踝骨折的患者踝关节不稳定骨折手术治疗后身体功能评分相对更低。[44]Bhandari M, Sprague S, Hanson B, et al. Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study. J Orthop Trauma. 2004;18:338-345.http://www.ncbi.nlm.nih.gov/pubmed/15213498?tool=bestpractice.com糖尿病患者几乎所有形态的踝关节骨折手术治疗后结果更差,住院时间更长,术后并发症更多。[47]Ganesh SP, Pietrobon R, Cecilio WA, et al. The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am. 2005;87:1712-1718.http://www.ncbi.nlm.nih.gov/pubmed/16085609?tool=bestpractice.com