Ferguson M, Brand C, Lowe A, Gabbe B, Dowrick A, Hart M, Richardson M
Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Victoria, Australia.
Injury. 2008 Feb;39(2):187-95. doi: 10.1016/j.injury.2007.03.012. Epub 2007 Sep 6.
Although most tibial shaft fractures are expected to heal within 24 weeks, the long-term effects of these injuries on patients in terms of self-reported health status, disability, and pain are largely unknown.
To investigate the clinical and patient-reported outcomes of patients with isolated tibial shaft fractures treated at the two level 1 adult trauma centres in Victoria, Australia.
Sixty patients with isolated tibial shaft fractures treated at the Royal Melbourne Hospital and the Alfred Hospital between August 2003 and August 2004 were identified via the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Patient-reported outcomes were prospectively measured 1 year post-injury using the 12-Item Short-Form Health Survey (SF-12) (also administered at baseline); the Work subscale of the Sickness Impact Profile; and a Numerical Rating Scale for pain. A priori defined clinical outcomes were also determined by retrospectively reviewing hospital medical records and X-rays.
Full weight-bearing status was achieved after a median inter quartile range (IQR) time of 14.0 (12.5-20.0) weeks, and the median (IQR) time to radiological union was 35.8 (23.3-51.6) weeks. Sixty percent of patients completed the SF-12 at both baseline and 12 months post-injury. Although there were no clear changes in mental health scores (median change=+1.0; IQR=-3.5 to 4.0; p=0.52), physical health scores were significantly reduced (median change=-3.0; IQR=-19.5 to 0.3; p=0.003). Additionally, 47% of patients reported work-related disability and 40% experienced persistent pain 1 year post-injury.
These results indicate that long-term physical disability remains a problem for many patients following tibial shaft fracture, and they should be considered when providing prognostic information to patients. Further research is required to identify the specific health problems experienced as well as the factors contributing to disability in order to inform post-fracture rehabilitation planning.
尽管大多数胫骨干骨折预计在24周内愈合，但这些损伤对患者自我报告的健康状况、残疾程度和疼痛方面的长期影响在很大程度上尚不清楚。
调查在澳大利亚维多利亚州的两家一级成人创伤中心接受治疗的孤立胫骨干骨折患者的临床和患者报告的结局。
通过维多利亚州骨科创伤结局登记处（VOTOR）确定了2003年8月至2004年8月期间在皇家墨尔本医院和阿尔弗雷德医院接受治疗的60例孤立胫骨干骨折患者。使用12项简短健康调查（SF-12）（基线时也进行了此项调查）在受伤后1年对患者报告的结局进行前瞻性测量；疾病影响概况的工作子量表；以及疼痛数字评定量表。还通过回顾医院病历和X线片回顾性地确定了预先定义的临床结局。
在中位数四分位间距（IQR）时间为14.0（12.5 - 20.0）周后达到完全负重状态，放射学愈合的中位数（IQR）时间为35.8（23.3 - 51.6）周。60%的患者在基线和受伤后12个月均完成了SF-12调查。尽管心理健康评分没有明显变化（中位数变化 = +1.0；IQR = -3.5至4.0；p = 0.52），但身体健康评分显著降低（中位数变化 = -3.0；IQR = -19.5至0.3；p = 0.003）。此外，47% 的患者报告有与工作相关的残疾，40% 的患者在受伤后1年仍有持续性疼痛。
这些结果表明，胫骨干骨折后长期身体残疾对许多患者来说仍然是一个问题，在向患者提供预后信息时应予以考虑。需要进一步研究以确定所经历的具体健康问题以及导致残疾的因素，以便为骨折后康复计划提供依据。
