关键词: 踝关节骨折, 踝穴, 踝关节功能, 踝关节活动度, 预后, 影像学, 肌力, 影响因素

Abstract: BACKGROUND: The recovery of joint anatomical morphology after ankle fracture surgery has a great impact on the range of motion and joint function. Previous studies only focused on the postoperative height recovery of ankle acupoints, so it is of great significance to study the correlation between the morphological changes of ankle acupoints and the functional changes after fracture surgery.  
OBJECTIVE: To explore the correlation between the morphological changes of ankle acupoints, ankle joint function and ankle joint range of motion after ankle joint fracture surgery, and analyze the prognostic factors of ankle joint function.
METHODS:  A total of 268 patients with unilateral ankle fractures admitted to General Hospital of Jizhong Energy Xingtai Mining Group Co., Ltd. from January 2017 to December 2018 were included in this study. According to the Mazur scoring method, the function of the affected ankle joint of all patients was scored and grouped: 132 cases in the excellent group (93-100 scores), 65 cases in good group (87-92 scores), and 71 cases in average and poor group (< 87 scores). The difference between the morphological indicators (width, depth, sagittal angle and coronal angle of the ankle acupoint) on the affected side and the uninfected side of the patients was compared in different groups at the last follow-up. Pearson correlation was used to analyze the correlation between the morphological change indicators of ankle acupoints, ankle joint function and ankle joint range of motion. Multivariate ordered logistic regression was used to analyze the related independent risk factors affecting the recovery of the patient’s ankle joint function.  
RESULTS AND CONCLUSION: (1) Compared with the healthy side, the width and depth of the ankle acupoint on the affected side, as well as the coronal and sagittal angles were significantly increased (P < 0.001); and the patient’s dorsiflexion range of motion, plantar flexion range of motion, dorsiflexor strength, and strength of plantar flexor muscles decreased significantly on the affected side (P < 0.001). (2) At the last follow-up, there were statistically significant differences in the ankle acupoint width, ankle acupoint depth, coronal angle, and sagittal angle difference between the affected side and the healthy side of the three groups of patients in the excellent, good, average and poor groups (P < 0.001). (3) Pearson correlation analysis showed that the width of the ankle acupoint, the depth of the ankle acupoint, the coronal angle, and the sagittal angle of the affected side of the patient were significantly negatively correlated with the degree of dorsiflexion range of motion, plantar flexion range of motion, dorsiflexor strength, and plantar flexor strength (P < 0.05). (4) The results of multiple ordered logistic regression analysis showed that age > 60 years old, fracture classification, starting recovery time > 7 days, no calcaneal traction, and ankle acupoint morphology indicators (the width of ankle acupoints on the affected side and the uninfected side, the depth of ankle acupoints, and the coronal position angle and sagittal angle difference) were independent factors that affect the functional recovery of patients with ankle fractures after surgery, and not conducive to the recovery of ankle joint function. (5) Above results confirmed that there was a negative correlation of ankle hole shape change with the function of ankle joint and ankle range of motion. The ankle hole width, ankle hole depth, coronal and sagittal position angle difference between the affected side and the healthy side increased. Older age, no calcaneal traction, late rehabilitation training time, and type C fractures were independent risk factors for the knee joint function decline. Therefore, clinical attention should be paid to these patients.

Key words: ankle joint fracture, ankle acupoint, ankle joint function, ankle joint range of motion, prognosis,  imaging,  myodynamia, influencing factors