Sugi Michelle T, Davidovitch Roy, Montero Nicole, Nobel Tamar, Egol Kenneth A
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Orthopedics. 2012 Sep;35(9):e1376-82. doi: 10.3928/01477447-20120822-25.
A retrospective review of surgically treated lower-extremity long-bone fractures in wheelchair-bound patients was conducted. Between October 2000 and July 2009, eleven lower-extremity fractures in 9 wheelchair-bound patients underwent surgical fixation. The Short Musculoskeletal Function Assessment, Short Form, and Spinal Cord Injury Quality of Life questionnaires were used to assess functional outcome. Mechanism of injury for all patients was a low-energy fall that occurred while transferring. Four patients who sustained a distal femur fracture, 1 patient who sustained a distal femur fracture and a subsequent proximal tibia fracture, and 1 patient who sustained a proximal third tibia shaft fracture underwent open reduction and internal fixation with plates and screws. Three patients with 4 midshaft tibia fractures underwent intramedullary nailing. At last follow-up, all 9 patients had returned to their baseline preoperative function. Quality of life was significantly higher (P<.01) than the Spinal Cord Injury Quality of Life questionnaire's reference score. Self-reported visual analog scale pain scores improved significantly from time of fracture to last follow-up (P=.02). All fractures achieved complete union, and no complications were reported. This study's findings demonstrate that operative treatment in active, wheelchair-bound patients can provide an improved quality of life postinjury and a rapid return to activities.
对轮椅使用者的下肢长骨骨折手术治疗进行了回顾性研究。2000年10月至2009年7月期间，9例轮椅使用者的11处下肢骨折接受了手术固定。使用简短肌肉骨骼功能评估简表和脊髓损伤生活质量问卷来评估功能结果。所有患者的损伤机制均为转移过程中发生的低能量跌倒。4例股骨远端骨折患者、1例股骨远端骨折并随后发生胫骨近端骨折的患者以及1例胫骨近端三分之一骨干骨折的患者接受了钢板螺钉切开复位内固定术。3例有4处胫骨干骨折的患者接受了髓内钉固定术。在最后一次随访时，所有9例患者均恢复到术前基线功能。生活质量显著高于脊髓损伤生活质量问卷的参考评分（P<0.01）。自我报告的视觉模拟量表疼痛评分从骨折时到最后一次随访有显著改善（P=0.02）。所有骨折均实现完全愈合，且未报告并发症。本研究结果表明，对于活跃的轮椅使用者，手术治疗可提高伤后的生活质量并使其迅速恢复活动。
