Bydon Mohamad, De la Garza-Ramos Rafael, Macki Mohamed, Desai Atman, Gokaslan Aaron K, Bydon Ali
*The Spinal Column Biomechanics and Surgical Outcomes Laboratory and †Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Spine (Phila Pa 1976). 2014 Aug 15;39(18):E1103-9. doi: 10.1097/BRS.0000000000000448.
Retrospective study of an administrative database.
To estimate the incidence of sacral fractures in the United States and report short-term outcomes after their surgical management.
The incidence of sacral fractures in the United States is currently unknown, and these lesions have been associated with significant morbidity after their surgical management.
This study used the Nationwide Inpatient Sample database for the years 2002-2011. All patients with a primary discharge diagnosis of a sacral fracture with and without a neurological injury were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients with a diagnosis of osteoporosis or pathological fracture were excluded. A stepwise multivariate logistic regression analysis was performed to identify factors associated with an in-hospital complication.
During the study period, 10,177 patients with a nonosteoporotic sacral fracture were identified, of whom 1002 patients underwent surgery. Between 2002 and 2011, the estimated incidence of sacral fractures increased from 0.67 per 100,000 persons to 2.09 (P < 0.001). Similarly, the rate of surgical treatment for sacral fractures increased from 0.05 per 100,000 persons in 2002 to 0.24 per 100,000 in 2011 (P < 0.001). Complications occurred in 25.95% of patients and remained steady over time (P = 0.992). Average length of stay significantly decreased from 11.93 days to 9.66 days in the 10-year period (P = 0.023). The independent factors associated with an in-hospital complication were congestive heart failure (odds ratio, 3.65; 95% confidence interval, 1.18-11.26), coagulopathy (odds ratio, 3.58; 95% confidence interval, 1.88-6.81), and electrolyte abnormalities (odds ratio, 3.28; 95% confidence interval, 2.14-5.02).
During the examined 10-year period, both the incidence of nonosteoporotic sacral fractures and the surgical treatment of these lesions increased in the United States. Between 2002 and 2011, although patient comorbidity increased, in-hospital complication rates remained stable and length of stay significantly decreased over time.
对一个行政数据库的回顾性研究。
评估美国骶骨骨折的发病率，并报告其手术治疗后的短期结果。
美国骶骨骨折的发病率目前尚不清楚，且这些损伤在手术治疗后与显著的发病率相关。
本研究使用了2002 - 2011年的全国住院患者样本数据库。使用国际疾病分类第九版临床修订本编码识别所有主要出院诊断为骶骨骨折且伴有或不伴有神经损伤的患者。排除诊断为骨质疏松或病理性骨折的患者。进行逐步多因素逻辑回归分析以确定与院内并发症相关的因素。
在研究期间，识别出10177例非骨质疏松性骶骨骨折患者，其中1002例患者接受了手术。2002年至2011年期间，骶骨骨折的估计发病率从每10万人0.67例增加到2.09例（P < 0.001）。同样，骶骨骨折的手术治疗率从2002年的每10万人0.05例增加到2011年的每10万人0.24例（P < 0.001）。25.95%的患者发生了并发症，且随时间保持稳定（P = 0.992）。在这10年期间，平均住院时间从11.93天显著缩短至9.66天（P = 0.023）。与院内并发症相关的独立因素为充血性心力衰竭（比值比，3.65；95%置信区间，1.18 - 11.26）、凝血障碍（比值比，3.58；95%置信区间，1.88 - 6.81）和电解质异常（比值比，3.28；95%置信区间，2.14 - 5.02）。
在研究的10年期间，美国非骨质疏松性骶骨骨折的发病率和这些损伤的手术治疗率均有所增加。2002年至2011年期间，尽管患者合并症增加，但院内并发症发生率保持稳定，住院时间随时间显著缩短。
4级。
