Madhu R, Kotnis R, Al-Mousawi A, Barlow N, Deo S, Worlock P, Willett K
John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
J Bone Joint Surg Br. 2006 Sep;88(9):1197-203. doi: 10.1302/0301-620X.88B9.17588.
This is a retrospective case review of 237 patients with displaced fractures of the acetabulum presenting over a ten-year period, with a minimum follow-up of two years, who were studied to test the hypothesis that the time to surgery was predictive of radiological and functional outcome and varied with the pattern of fracture. Patients were divided into two groups based on the fracture pattern: elementary or associated. The time to surgery was analysed as both a continuous and a categorical variable. The primary outcome measures were the quality of reduction and functional outcome. Logistic regression analysis was used to test our hypothesis, while controlling for potential confounding variables. For elementary fractures, an increase in the time to surgery of one day reduced the odds of an excellent/good functional result by 15% (p = 0.001) and of an anatomical reduction by 18% (p = 0.0001). For associated fractures, the odds of obtaining an excellent/good result were reduced by 19% (p = 0.0001) and an anatomical reduction by 18% (p = 0.0001) per day. When time was measured as a categorical variable, an anatomical reduction was more likely if surgery was performed within 15 days (elementary) and five days (associated). An excellent/good functional outcome was more likely when surgery was performed within 15 days (elementary) and ten days (associated). The time to surgery is a significant predictor of radiological and functional outcome for both elementary and associated displaced fractures of the acetabulum. The organisation of regional trauma services must be capable of satisfying these time-dependent requirements to achieve optimal patient outcomes.
这是一项对237例髋臼移位骨折患者进行的回顾性病例研究，这些患者在十年期间就诊，至少随访两年，旨在检验手术时间能否预测放射学和功能结果以及是否随骨折类型而变化这一假设。根据骨折类型将患者分为两组：单纯型或复合型。将手术时间作为连续变量和分类变量进行分析。主要结局指标为复位质量和功能结果。在控制潜在混杂变量的同时，采用逻辑回归分析来检验我们的假设。对于单纯骨折，手术时间每增加一天，获得优秀/良好功能结果的几率降低15%（p = 0.001），获得解剖复位的几率降低18%（p = 0.0001）。对于复合型骨折，每天获得优秀/良好结果的几率降低19%（p = 0.0001），获得解剖复位的几率降低18%（p = 0.0001）。当将时间作为分类变量测量时，如果在15天内（单纯型）和5天内（复合型）进行手术，则更有可能实现解剖复位。如果在15天内（单纯型）和10天内（复合型）进行手术，则更有可能获得优秀/良好的功能结果。手术时间是髋臼单纯型和复合型移位骨折放射学和功能结果的重要预测指标。区域创伤服务机构的组织必须能够满足这些时间依赖性要求，以实现最佳的患者预后。
