Mkandawire Nyengo C, Boot Dalton A, Braithwaite Ian J, Patterson Mal
Warrington Hospital NHS Trust, Lovely Lane, Warrington Cheshire WA5 1QG, UK.
Injury. 2002 Mar;33(2):111-5. doi: 10.1016/s0020-1383(01)00047-x.
Five years after severe injury (ISS>15), usually involving several body regions, 158 patients were assessed regarding their musculo-skeletal recovery. An earlier paper in this journal about this study 'Injury 29 (1998) 55' showed that when considering the main body regions causing long term disability, 45% were due to bony injuries to the extremities, pelvis and shoulder girdle. We analysed these body areas regarding the degrees of disability and pain and also for problems with activities of daily living, work, sport and mobility. All patients with unstable pelvic fractures had moderate or severe persisting disability and chronic pain. Functional problems with activities of daily living, work, sport and mobility were reported in 28, 86, 100 and 100% of patients, respectively. Patients with stable pelvic fractures had persisting disability in 54% of cases, which was mild in 42% and moderate or severe in 12% of patients. In patients with stable pelvic fractures 54% had chronic pain, which was mild in 24% of patients and moderate or severe in 30% of patients. Functional problems with mobility, work and sport were reported in 38, 19 and 19% of patients, respectively. Patients with shoulder girdle injuries had persisting disability in 48% of cases which was mild in 24% and moderate or severe in 24% of patients. In patients with shoulder girdle injuries 45% had chronic pain, which was mild in 14% and moderate or severe in 31% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 38, 28, 38 and 38% of patients respectively. Patients with upper limb fractures had persisting disability in 66% of cases which was mild in 34% of patients and moderate or severe in 32% of patients. Chronic pain was present in 62% of these cases, which was mild in 32% and moderate or severe in 34% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 31, 45, 48 and 66% of patients, respectively. Patients with lower limb fractures had persisting disability in 84% of cases, which was mild in 16% and moderate or severe in 68% of patients. Chronic pain was present in 80% of these cases, which was mild in 24% and moderate or severe in 56% of patients. Functional problems with activities of daily living, work, sport and mobility were reported in 40, 56, 64 and 76% of patients, respectively. Patients with multiple extremity injuries or combinations of pelvic and lower extremity or shoulder girdle and upper extremity injuries were much more likely to have continuing disability compared with those sustaining single bone injuries of that limb. This high disability rate reflecting treatment in 1989-1990, raises the question of whether our present policy of earlier and better fixation and rehabilitation of fractures in severely injured patients (ISS>15) can improve these results.
在严重受伤（损伤严重度评分>15）五年后（通常涉及多个身体部位），对158例患者的肌肉骨骼恢复情况进行了评估。该杂志此前一篇关于本研究的论文《Injury 29 (1998) 55》表明，在考虑导致长期残疾的主要身体部位时，45%是由于四肢、骨盆和肩胛带的骨损伤。我们分析了这些身体部位的残疾程度、疼痛情况以及日常生活活动、工作、运动和行动方面的问题。所有不稳定骨盆骨折患者均有中度或重度持续性残疾和慢性疼痛。分别有28%、86%、100%和100%的患者报告了日常生活活动、工作、运动和行动方面的功能问题。稳定骨盆骨折患者中，54%存在持续性残疾，其中42%为轻度，12%为中度或重度。稳定骨盆骨折患者中，54%有慢性疼痛，其中24%为轻度，30%为中度或重度。分别有38%、19%和19%的患者报告了行动、工作和运动方面的功能问题。肩胛带损伤患者中，48%存在持续性残疾，其中24%为轻度，24%为中度或重度。肩胛带损伤患者中，45%有慢性疼痛，其中14%为轻度，31%为中度或重度。分别有38%、28%、38%和38%的患者报告了日常生活活动、工作、运动和行动方面的功能问题。上肢骨折患者中，66%存在持续性残疾，其中34%为轻度，32%为中度或重度。这些病例中62%存在慢性疼痛，其中32%为轻度，34%为中度或重度。分别有31%、45%、48%和66%的患者报告了日常生活活动、工作、运动和行动方面的功能问题。下肢骨折患者中，84%存在持续性残疾，其中16%为轻度，68%为中度或重度。这些病例中80%存在慢性疼痛，其中24%为轻度，56%为中度或重度。分别有40%、56%、64%和76%的患者报告了日常生活活动、工作、运动和行动方面的功能问题。与那些仅遭受该肢体单处骨折的患者相比，多肢体损伤或骨盆与下肢或肩胛带与上肢联合损伤的患者更有可能持续残疾。这种反映1989 - 1990年治疗情况的高残疾率，引发了一个问题，即我们目前对严重受伤患者（损伤严重度评分>15）骨折进行早期更好的固定和康复的政策是否能改善这些结果。
