Jameson Simon S, Rankin Kenneth S, Desira Nicola L, James Philip, Muller Scott D, Reed Mike R, Rangan Amar
National Orthopaedic Research and Surgical Outcomes Collaboration, UK; Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle NE15 8NY, UK.
Northern Deanery Trauma & Orthopaedic Training Scheme, Waterfront 4, Goldcrest Way, Newcastle NE15 8NY, UK.
Injury. 2014 Aug;45(8):1256-61. doi: 10.1016/j.injury.2014.05.009. Epub 2014 May 17.
The majority of ankle fractures are stable and can be treated without an operation, most commonly with cast immobilisation. Based on concerns regarding the risk of a venous thromboembolic event (VTE) while immobilised, there is currently debate as to whether these patients should receive VTE prophylaxis for the duration of treatment. Rates of pulmonary embolism (PE) in this patient group are unknown. This retrospective cohort study was designed to identify patients treated without an operation for ankle fracture and determine the occurrence of PE and inpatient mortality within 90 days of injury using the English National Health Service administrative databases. Logistic regression models were used to assess the influence of age, gender and Charlson co-morbidity score on these outcomes. We identified 14777 adult patients over a 54-month period (April 2007-September 2011) that met our linkage and inclusion criteria (isolated, unilateral closed ankle fracture that did not require hospitalisation). Mean age was 46.4 years (range 18-99) and the majority had a Charlson 0 score (97.7%). There were 32 (0.22%) PEs within 90 days of the fracture (including in one patient who subsequently died). After adjustment, Charlson score of ≥1 was associated with a greater risk of PE (Odds ratio = 11.97, p < 0.001) compared to Charlson 0. Risk for these patients was 2.08%. In total, fifteen patients (0.11%) died in hospital within 90 days. Pulmonary embolism is rare following ankle fractures treated without an operation. Patients with multiple co-morbidities are at a higher risk. Based on this evidence, an ankle fracture treated without an operation does not appear to be an indication for routine VTE prophylaxis.
大多数踝关节骨折是稳定的，无需手术即可治疗，最常见的治疗方法是石膏固定。鉴于对固定期间发生静脉血栓栓塞事件（VTE）风险的担忧，目前对于这些患者在治疗期间是否应接受VTE预防存在争议。该患者群体中肺栓塞（PE）的发生率尚不清楚。这项回顾性队列研究旨在通过英国国家医疗服务体系行政数据库，识别接受非手术治疗的踝关节骨折患者，并确定受伤后90天内PE的发生情况和住院死亡率。使用逻辑回归模型评估年龄、性别和Charlson合并症评分对这些结果的影响。我们在54个月期间（2007年4月至2011年9月）确定了14777例成年患者，他们符合我们的关联和纳入标准（孤立性、单侧闭合性踝关节骨折，无需住院治疗）。平均年龄为46.4岁（范围18 - 99岁），大多数患者Charlson评分为0（97.7%）。骨折后90天内有32例（0.22%）发生PE（其中1例患者随后死亡）。调整后，Charlson评分为≥1与PE风险增加相关（比值比 = 11.97，p < 0.001），而Charlson评分为0的患者风险为2.08%。共有15例患者（0.11%）在90天内住院死亡。非手术治疗的踝关节骨折后肺栓塞很少见。患有多种合并症的患者风险更高。基于这些证据，非手术治疗的踝关节骨折似乎并非常规VTE预防的指征。
