Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelstrasse 30, Aachen, Germany.
J Trauma Acute Care Surg. 2012 Feb;72(2):467-72. doi: 10.1097/ta.0b013e318219fbfa.
The long-term clinical status of surviving patients with multiple injuries has not been well described. The aim of this study was to evaluate the long-term outcome of acetabular and lower limb injuries.
Patients treated at a Level I trauma center at least 10 years before participation in this study were invited for a follow-up physical examination. Six hundred thirty-seven patients were examined. Inclusion criteria are as follows: Injury Severity Score ≥16 Points;treatment in a Level I trauma center; and injuries of the lower limb: fractures of the acetabulum, proximal femur, femoral shaft,knee joint, and tibial shaft. Exclusion criteria are as follows: incomplete follow-up examination, amputations, ankle and foot fractures, and patients older than 60 years and younger than 3 years. The follow-up examination included the following parameters:range of motion, pain, limping, successful rehabilitation, and outcome scores.
Of 525 patients with fractures of the acetabulum and lower limb, 229 patients fulfilled the inclusion criteria. Mean age: 24.9 (range,3–60) years; Injury Severity Score: 19.66 (range, 16–43). The most frequent rates of ongoing local pain were stated by patients with fractures of the acetabulum (50%) and the proximal femur (45%). Moreover, the incidence of abnormal gait was significantly lower in patients with femoral shaft fractures when compared with the patients with fractures of the acetabulum (3.7% vs. 35%;p 0.0001), proximal femur (3.7% vs. 20%; p≤ 0.006), and tibial shaft (3.7% vs. 14.7%; p = 0.023).
Our results demonstrate a better long-term outcome in patients with femur shaft fractures, whereas patients with articular fractures and proximal femur fractures were associated with poorer outcomes. Fracture location is determining factor for long-term outcome
多发伤幸存患者的长期临床状况尚未得到很好的描述。本研究的目的是评估髋臼和下肢损伤的长期预后。
邀请至少在参与本研究 10 年前在一级创伤中心接受治疗的患者进行随访体检。共检查了 637 名患者。纳入标准如下：损伤严重程度评分≥16 分；在一级创伤中心治疗；下肢损伤：髋臼、股骨近端、股骨干、膝关节和胫骨骨干骨折。排除标准如下：随访检查不完整、截肢、踝关节和足部骨折、年龄大于 60 岁且小于 3 岁的患者。随访检查包括以下参数：运动范围、疼痛、跛行、康复成功和结局评分。
在 525 例髋臼和下肢骨折患者中，有 229 例符合纳入标准。平均年龄：24.9（范围，3-60）岁；损伤严重程度评分：19.66（范围，16-43）。髋臼骨折和股骨近端骨折患者持续局部疼痛的发生率最高（分别为 50%和 45%）。此外，与髋臼骨折患者（3.7%比 35%；p 0.0001）、股骨近端骨折患者（3.7%比 20%；p≤0.006）和胫骨骨干骨折患者（3.7%比 14.7%；p=0.023）相比，股骨干骨折患者发生异常步态的发生率显著较低。
我们的结果表明，股骨干骨折患者的长期预后较好，而关节内骨折和股骨近端骨折患者的预后较差。骨折部位是长期预后的决定因素。
