Weckbach S, Flierl M A, Huber-Lang M, Gebhard F, Stahel P F
Denver Health Medical Center, Department of Orthopaedic Surgery, University of Colorado Denver, School of Medicine , 777 Bannock Street, 80204, Denver, USA.
Unfallchirurg. 2011 Oct;114(10):938-42. doi: 10.1007/s00113-011-2066-y.
In many European countries, patients requiring surgical treatment of ankle fractures are generally hospitalized for an average of 8-11 days. This anecdotal concept is largely based on the premise that the inpatient monitoring of soft tissue conditions may lead to a decreased complication rate. The present study was designed to test the hypothesis that the surgical care of isolated ankle fractures as an outpatient procedure represents a safe and feasible concept which is not associated with an increased complication rate.
A retrospective analysis was performed of a prospective database during a 5-year period (01/01/2005-12/31/2009) at a US academic level 1 trauma center with an institutional protocol of outpatient surgery for isolated ankle fractures. All fractures were classified according to the AO/OTA system. Outcome parameters consisted of the rate of postoperative complications and frequency of unplanned surgical revisions outpatient isolated versus inpatient isolated with surgical fixation of ankle isolated fractures.
Among 810 consecutive patients with ankle fractures during the study period, 476 met the inclusion criteria. Of these, 256 patients (53.8%) were treated as outpatients. The average length of stay of patients who were admitted as inpatients was 1.5±0.8 days (range 1-5 days). The age distribution was in a similar range for inpatients and outpatients (39±14.1 vs 35±12.8 years), and the injury severity based on the AO/OTA fracture classification revealed a similar distribution of fracture patterns in both groups. The rate of postoperative complications (9.1 vs 3.1%) and of unplanned surgical revisions (3.6 vs 1.2%) was significantly increased in the hospitalized group, compared to patients with ambulatory surgery (P<0.05).
The surgical treatment of isolated ankle fractures as an outpatient procedure represents a safe and resource-efficient concept which is not associated with an increased complication rate. Cultural differences in the domestic environment of individual patients may have to be taken into consideration.
在许多欧洲国家，需要接受踝关节骨折手术治疗的患者通常平均住院8 - 11天。这种传闻性的观念很大程度上基于这样一种前提，即对软组织状况进行住院监测可能会降低并发症发生率。本研究旨在验证以下假设：将单纯踝关节骨折的手术治疗作为门诊手术是一种安全可行的方案，且不会导致并发症发生率增加。
对美国一家一级学术创伤中心在5年期间（2005年1月1日至2009年12月31日）的前瞻性数据库进行回顾性分析，该中心有针对单纯踝关节骨折的门诊手术机构方案。所有骨折均根据AO/OTA系统进行分类。结果参数包括术后并发症发生率以及门诊单纯手术与住院单纯手术治疗踝关节单纯骨折后计划外手术翻修的频率。
在研究期间连续的810例踝关节骨折患者中，476例符合纳入标准。其中，256例患者（53.8%）接受了门诊治疗。住院患者的平均住院时间为1.5±0.8天（范围1 - 5天）。住院患者和门诊患者的年龄分布范围相似（39±14.1岁对35±12.8岁），并且基于AO/OTA骨折分类的损伤严重程度显示两组骨折类型分布相似。与门诊手术患者相比，住院组的术后并发症发生率（9.1%对3.1%）和计划外手术翻修率（3.6%对1.2%）显著增加（P<0.05）。
将单纯踝关节骨折的手术治疗作为门诊手术是一种安全且资源高效的方案，且不会导致并发症发生率增加。可能需要考虑个体患者国内环境中的文化差异。
