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[手术治疗骨盆环和髋臼骨折对姿势控制的影响]

[Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

作者信息

Lang P, Schnegelberger A, Riesner H-J, Stuby F, Friemert B, Palm H-G

机构信息

Klinik für Unfallchirurgie und Orthopädie, Bundeswehrkrankenhaus Ulm.

Klinik für Unfall- und Wiederherstellungschirurgie der Eberhard-Karls-Universität Tübingen, BG Unfallklinik Tübingen.

出版信息

Z Orthop Unfall. 2016 Apr;154(2):174-80. doi: 10.1055/s-0041-110811. Epub 2016 Feb 4.

Abstract

BACKGROUND

The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group.

PATIENTS AND METHODS

A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters.

RESULTS

It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population.

CONCLUSION

Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully treatment of fractures.

摘要

背景

骨盆环和髋臼骨折的手术治疗目的是使患者能够迅速活动,以恢复站立和步态稳定性(姿势控制),因为这与良好的治疗结果显著相关。姿势稳定性的调节主要由本体感觉刺激的传递控制。此外,骨盆作为腿部和脊柱之间的连接结构,因此对机械稳定也非常重要。目前尚不清楚骨盆环和髋臼骨折的手术治疗是否会影响姿势控制的调节。因此,本研究的目的是通过计算机动态姿势描记法(CDP),在平均35个月后检查手术治疗的骨盆环和髋臼骨折对姿势稳定性的影响,并将结果与健康对照组进行比较。

患者与方法

采用CDP对38例接受手术治疗的骨盆环和髋臼骨折患者及38名健康志愿者进行回顾性病例对照研究。平均随访时间为35(12 - 78)个月。本研究中最重要的结局参数是总体稳定性指数(OSI)。髋关节活动度、健康相关生活质量(SF - 12)和疼痛是补充结局参数。

结果

发现手术治疗的骨盆环和髋臼骨折对姿势稳定性没有影响。患者组的OSI为2.1°,对照组为1.9°。两组在髋关节活动度方面无显著差异。共有52%的患者无疼痛或仅有轻微疼痛。平均健康相关生活质量与总体人群相同。

结论

手术治疗的骨盆环和髋臼骨折在中期不会导致姿势控制恶化。这对于患者的快速活动具有很高的预后重要性。因此,骨折成功治疗后预计不会增加跌倒风险。

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