Gabbe Belinda J, Hofstee Dirk-Jan, Esser Max, Bucknill Andrew, Russ Matthias K, Cameron Peter A, Handley Christopher, de Steiger Richard N
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
College of Medicine, Swansea University, Swansea, UK.
ANZ J Surg. 2015 Oct;85(10):749-54. doi: 10.1111/ans.12700. Epub 2014 May 30.
There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture.
Adult survivors to discharge from two major trauma centres with AO/Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional (Glasgow Outcome Scale-Extended [GOS-E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome.
A total of 111 of 114 (97%) cases were followed up. The mean (SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently (GOS-E > 4) and 59% had returned to work. Higher Injury Severity Scores (ISS) were associated with lower risk-adjusted odds of return to work (P = 0.04) and independent living (P = 0.06). Post-operative infection was associated with living independently (P = 0.02).
Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.
关于严重骨盆环骨折长期预后的证据有限。本研究的目的是描述严重骨盆环骨折后的长期独立生活及重返工作岗位的预后情况。
从两个主要创伤中心出院的成年AO/Tile B型和C型骨折幸存者在受伤后6个月、12个月和24个月接受随访，以获取功能（扩展格拉斯哥预后量表[GOS-E]）和重返工作岗位的数据。采用多变量混合效应模型来确定预后的预测因素。
114例患者中有111例（97%）接受了随访。参与者的平均（标准差）年龄为41.9（18.9）岁，77%为男性，81%与交通相关，90%为多发伤患者。此外，11%采用保守治疗，10%采用外固定，79%采用切开复位内固定。在24个月时，77%的患者能够独立生活（GOS-E>4），59%的患者已重返工作岗位。较高的损伤严重程度评分（ISS）与较低的经风险调整的重返工作岗位几率（P = 0.04）和独立生活几率（P = 0.06）相关。术后感染与独立生活相关（P = 0.02）。
尽管受伤严重，但7%的严重骨盆环骨折患者在受伤2年后能够独立生活，59%的患者已重返工作岗位。骨折类型和治疗方式并非预后的关键预测因素。需要开展大规模多中心研究，以全面了解严重骨盆环骨折的负担并指导临床治疗。
