手术后治疗的侧方挤压骨盆损伤后持续的损伤。
Persistent impairment after surgically treated lateral compression pelvic injury.
机构信息
Grand Rapids Medical Educational Partners, Grand Rapids, MI, USA.
出版信息
Clin Orthop Relat Res. 2012 Aug;470(8):2161-72. doi: 10.1007/s11999-012-2247-1.
BACKGROUND
Recently, fixation of lateral compression (LC) pelvic fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing adverse systemic effects. However, the degree of acceptable deformity and persistence of disability are unclear.
QUESTIONS/PURPOSES: We determined if (1) injury pattern; (2) demographics; (3) final posterior displacement; (4) L5/S1 involvement; (5) associated injuries; and (6) time influence outcome measurements, sexual dysfunction, and pain.
METHODS
We retrospectively reviewed 119 patients with unstable LC injuries treated surgically between 2000 and 2010. There were 52 males and 67 females; mean age was 39 years with a mean body mass index of 27 kg/m(2). All patients underwent clinical examination and radiographic imaging for instability and accompanying injuries. We obtained Short Musculoskeletal Function Assessment (SMFA). The minimum followup was 12 months (mean, 33 months; range, 12-100 months).
RESULTS
SMFA subscores were not affected by injury pattern and demographics. Posterior reduction was less than 5 mm with persistent displacement in 99 of 119 (83%). Displacement of 5 to 10 mm did not affect any SMFA subscore at any time interval. Patients with additional lower extremity injuries had worse SMFA scores. Function improved with time. A visual analog scale pain score of 4 or more at 6 months predicted pain and overall SMFA score at last followup.
CONCLUSIONS
Unstable LC pelvic ring injuries result in persistent disability based on validated outcome measurements. Near anatomical reduction can be achieved and maintained. While our findings need to be confirmed in studies with high rates of followup, patients with unstable LC pelvic injuries should be counseled concerning the possibility of some degree of persistent disability.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
最近，人们提倡固定侧方压缩（LC）骨盆骨折，以提高患者的舒适度并允许更早地活动而不会丢失复位，从而最大限度地减少全身不良影响。但是，可接受的畸形程度和残疾的持续性尚不清楚。
问题/目的：我们确定了（1）损伤模式；（2）人口统计学；（3）最终的后方移位；（4）L5/S1 受累；（5）合并损伤；以及（6）时间是否会影响结果测量、性功能障碍和疼痛。
方法
我们回顾性分析了 2000 年至 2010 年间手术治疗的 119 例不稳定 LC 损伤患者。其中男性 52 例，女性 67 例；平均年龄 39 岁，平均体重指数为 27 kg/m²。所有患者均接受了不稳定和伴随损伤的临床检查和影像学检查。我们获得了短肢肌肉骨骼功能评估（SMFA）。最低随访时间为 12 个月（平均 33 个月；范围 12-100 个月）。
结果
SMFA 子评分不受损伤模式和人口统计学的影响。119 例中有 99 例（83%）的后方复位小于 5mm 且持续存在移位。5 至 10mm 的移位在任何时间间隔都不会影响任何 SMFA 子评分。有下肢其他损伤的患者 SMFA 评分较差。功能随时间改善。6 个月时疼痛视觉模拟评分（VAS）为 4 或更高预示着疼痛和总体 SMFA 评分在最后一次随访时的情况。
结论
不稳定 LC 骨盆环损伤会导致基于验证后的结果测量出现持续性残疾。可以实现并维持近乎解剖复位。虽然我们的发现需要在具有高随访率的研究中得到证实，但不稳定 LC 骨盆损伤的患者应被告知存在一定程度持续性残疾的可能性。
证据水平
IV 级，治疗研究。请参阅作者指南，以获得完整的证据水平描述。
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