双侧胫骨干骨折是否与不良结局风险增加相关？

Are bilateral tibial shaft fractures associated with an increased risk for adverse outcome?

作者信息

Lichte Philipp, Weber Christian, Sellei Richard M, Hildebrand Frank, Lefering Rolf, Pape Hans-Christoph, Kobbe Philipp

出版信息

Injury. 2014 Dec;45(12):1985-9. doi: 10.1016/j.injury.2014.10.005.

DOI:10.1016/j.injury.2014.10.005

PMID:25458064

Abstract

INTRODUCTION

Long bone fractures are assumed to be an independent risk factor for systemic complications and death after trauma. Multiple studies have identified an increased risk for mortality and morbidity in patients with bilateral femoral fractures. Data about bilateral tibial shaft fractures is rare. The aim of our study was to analyze if patients with bilateral tibial shaft fractures are at higher risk for systemic complications.

METHODS

We performed a retrospective analysis of the TraumaRegister DGU® from 1993 to 2008. Inclusion criteria were unilateral or bilateral tibial shaft fractures and an age ≥16. Additionally to the overall collective we analyzed different subgroups (divided into different injury severities and treatment periods).

RESULTS

1899 patients with unilateral and 175 patients with bilateral tibial shaft fractures were included. Age, gender and mean ISS (25.8 vs. 26.2, p = 0.51) in the two groups were comparable. Regarding the entire study population, patients with bilateral tibial shaft fractures showed no significant higher incidence of respiratory organ failure (29.5% vs. 23.1%, p = 0.076) or mortality (20.0% vs. 16.3%, p = 0.203). However, subgroup analysis showed a significant higher rate of pulmonary organ failure for bilateral tibial shaft fractures as compared to unilateral tibial shaft fractures in the group ISS < 25 (20.7% vs. 11.7%, p = 0.023). Multivariate regression analysis identified the additional tibial shaft fracture as an independent risk factor for pulmonary organ failure (OR = 1.56) but not for mortality.

DISCUSSION

The additional tibial shaft fracture is an independent risk factor for pulmonary organ failure but not for multiple organ failure or mortality. The impact of the additional tibial shaft fracture is especially pronounced in less severely injured patients (ISS < 25). These findings are comparable to results of bilateral femoral fracture studies and we therefore suggest to treat patients with bilateral tibial shaft fractures with the same caution as those with bilateral femoral fractures.

摘要

引言

长骨骨折被认为是创伤后发生全身并发症和死亡的独立危险因素。多项研究已确定双侧股骨骨折患者的死亡和发病风险增加。关于双侧胫骨干骨折的数据很少。我们研究的目的是分析双侧胫骨干骨折患者是否有更高的全身并发症风险。

方法

我们对1993年至2008年的创伤注册数据库DGU®进行了回顾性分析。纳入标准为单侧或双侧胫骨干骨折且年龄≥16岁。除了整个总体外，我们还分析了不同的亚组（分为不同的损伤严重程度和治疗时期）。

结果

纳入了1899名单侧胫骨干骨折患者和175名双侧胫骨干骨折患者。两组的年龄、性别和平均损伤严重度评分（25.8对2六岁，p = 0.51）具有可比性。就整个研究人群而言，双侧胫骨干骨折患者的呼吸器官衰竭发生率（29.5%对23.1%，p = 0.076）或死亡率（20.0%对16.3%，p = 0.203）没有显著更高。然而，亚组分析显示，在损伤严重度评分<25的组中，双侧胫骨干骨折患者的肺器官衰竭发生率显著高于单侧胫骨干骨折患者（20.7%对11.7%，p = 0.023）。多因素回归分析确定额外的胫骨干骨折是肺器官衰竭的独立危险因素（比值比=1.56），但不是死亡的危险因素。