Operative management of ankle fractures in patients with diabetes mellitus
Operative management of ankle fractures in patients with diabetes mellitus
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DOI：
10.3113/fai.2007.0006
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发表时间：
2007-01-01
影响因子：
2.7
通讯作者：
Debnath, Ujjwal K.
中科院分区：
文献类型：
--
作者：
Costigan, William;Thordarson, David B.;Debnath, Ujjwal K.
背景：多项研究证实糖尿病患者踝关节骨折治疗的风险增加。我们回顾了迄今为止这一复杂患者组的最大系列研究结果，以确定并发症的发生频率。研究方法：84例糖尿病患者采用标准固定技术对急性闭合性踝关节骨折进行切开复位内固定。51名男性和33名女性的平均年龄为49.3岁（22至77岁）。平均随访4.1年（11 ~ 97个月）。75例骨折闭合，9例开放。39名患者使用胰岛素，45名患者使用口服降糖药或饮食控制糖尿病。糖尿病并发症，包括肾病，高血压，周围血管疾病和神经病变进行了评估。糖尿病的管理、骨折分类和糖尿病并发症的存在通过卡方、ANOVA和单变量logistic回归进行评估，以确定这些因素的统计学显著性。结果：84例患者中有12例发生术后并发症。10名患者出现感染（8名为深部感染，2名为浅表感染）。12例术前有周围神经病变证据的患者中有4例发展为Charcot关节病。12例术前无足脉搏的患者中有10例发生并发症（p < 0.0001），12例周围神经病变患者中有11例发生并发症（p < 0.0001）。肾病（5例患者中的2例）和高血压（12例患者中的9例）存在并发症趋势。开放性骨折、胰岛素依赖性、患者年龄和骨折分类对结局无显著影响。结论：糖尿病合并急性踝关节骨折患者大多数可以行切开复位内固定术，无并发症。无足脉搏或周围神经病变的患者发生并发症的风险增加。
Background: Multiple studies have documented increased risks associated with treatment of ankle fractures in patients with diabetes mellitus. We reviewed our results in the largest series to date of this complex patient group to determine the frequency of complications. Methods: Eighty-four patients with diabetes had open reduction and internal fixation using standard fixation techniques for acute, closed ankle fractures. The 51 men and 33 women had an average age was 49.3 (22 to 77) years. The average followup was 4.1 years (11 to 97 months). Seventy-five fractures were closed and nine were open. Thirty-nine patients used insulin and 45 used oral hypoglycemics or diet for control of their diabetes. Diabetic complications, including nephropathy, hypertension, peripheral vascular disease, and neuropathy were evaluated. The management of diabetes, fracture classification, and presence of diabetic complications were assessed with chi-square, ANOVA, and univariate logistic regression to determine the presence of statistical significance for these factors. Results: Twelve of the 84 patients developed postoperative complications. Ten patients developed infections (eight deep and two superficial). Four of 12 patients with preoperative evidence of peripheral neuropathy developed Charcot arthropathy. Ten of 12 patients who had absent pedal pulses preoperatively developed complications (p < 0.0001) and 11 of 12 patients with peripheral neuropathy had complications (p < 0.0001). A trend towards complications was noted with nephropathy (two of five patients) and hypertension (nine of 12 patients). Open fractures, insulin dependence, patient age, and fracture classification had no significant effect on outcome. Conclusions: Most patients with diabetes can undergo open reduction and internal fixation of acute ankle fractures without complications. Patients with absent pedal pulses or peripheral neuropathy are at increased risk for complications.