Schottel Patrick C, O'Connor Daniel P, Brinker Mark R
Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1700, Houston, TX 77030.
Health and Human Performance, University of Houston, 3855 Holman, GAR104, Houston, TX 77204-6015. E-mail address:
J Bone Joint Surg Am. 2015 Sep 2;97(17):1406-10. doi: 10.2106/JBJS.N.01090.
Long bone nonunions have an important impact on a patient's quality of life. The purpose of this study was to compare long bone nonunions with use of the Time Trade-Off direct measure to compute utility scores and to determine which nonunion anatomic location had the lowest health-related quality of life. The Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health.
Eight hundred and thirty-two consecutive long bone nonunions with Time Trade-Off data were identified and were retrospectively studied from a prospectively collected patient database. Nonunions with infections and those involving the articular portion of the bone were recorded. Time Trade-Off utility scores were obtained for all nonunion cases upon their initial clinical evaluation by a single surgeon specializing in reconstructive trauma.
The mean utility score of our nonunion cohort was 0.68 and it differed significantly by long bone (p = 0.037). Nonunions of the forearm had the lowest utility score (0.54), followed by the clavicle (0.59), femur (0.68), tibia or fibula (0.68), and humerus (0.71). Post hoc tests showed that patients with nonunions of the forearm had significantly lower utility scores (p = 0.031) compared with all other bones.
Patients diagnosed with a long bone nonunion have a very low health-related quality of life. We found that this single cohort's mean utility score was 0.68. This result is well below that of illnesses such as type-I diabetes mellitus (0.88), stroke (0.81), and acquired immunodeficiency syndrome (0.79). We found that patients with forearm nonunions had the lowest utility scores.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
长骨骨不连对患者的生活质量有重要影响。本研究的目的是使用时间权衡直接测量法比较长骨骨不连，并计算效用评分，以确定哪种骨不连解剖位置的健康相关生活质量最低。时间权衡法评估患者愿意用剩余生命的百分之多少来换取完美健康。
从一个前瞻性收集的患者数据库中，回顾性研究了832例连续的有时间权衡数据的长骨骨不连病例。记录有感染的骨不连病例以及涉及骨关节部分的病例。由一名专门从事重建创伤的外科医生在所有骨不连病例初次临床评估时获取时间权衡效用评分。
我们的骨不连队列的平均效用评分为0.68，因长骨不同而有显著差异（p = 0.037）。前臂骨不连的效用评分最低（0.54），其次是锁骨（0.59）、股骨（0.68）、胫骨或腓骨（0.68）以及肱骨（0.71）。事后检验表明，与所有其他骨骼相比，前臂骨不连患者的效用评分显著更低（p = 0.031）。
被诊断为长骨骨不连的患者健康相关生活质量非常低。我们发现这个单一队列的平均效用评分为0.68。这一结果远低于I型糖尿病（0.88）、中风（0.81）和获得性免疫缺陷综合征（0.79）等疾病的评分。我们发现前臂骨不连患者的效用评分最低。
预后水平III。有关证据水平的完整描述，请参阅作者须知。
