先进成像技术在治疗低能量创伤所致老年骨盆环损伤方面缺乏临床实用性。

Advanced Imaging Lacks Clinical Utility in Treating Geriatric Pelvic Ring Injuries Caused by Low-Energy Trauma.

作者信息

Natoli Roman M, Fogel Harold A, Holt Daniel, Schiff Adam, Bernstein Mitchell, Summers Hobie D, Lack William

机构信息

*Department of Orthopedic Surgery, Shock Trauma Center, University of Maryland, Baltimore, MD; and †Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center Chicago, Maywood, IL.

出版信息

J Orthop Trauma. 2017 Apr;31(4):194-199. doi: 10.1097/BOT.0000000000000761.

DOI:10.1097/BOT.0000000000000761

PMID:27984444

Abstract

OBJECTIVES

Is advanced imaging necessary in the evaluation of pelvic fractures caused by low-energy trauma in elderly patients?

DESIGN

Retrospective review.

SETTING

Single institution, Level 1 Trauma Center.

PATIENTS

Age ≥60 years old treated for low-energy traumatic pelvic ring injuries.

INTERVENTION

None.

MAIN OUTCOMES

Posterior pelvic ring injuries diagnosed on advanced imaging, radiographic displacement, admission status, hospital length of stay, change in weight-bearing status recommendations, and whether operative treatment was pursued.

RESULTS

Eighty-seven patients met the inclusion criteria, of which 42 had advanced imaging to evaluate the posterior pelvic ring (10 magnetic resonance imaging, 32 computed tomography). More posterior pelvic ring injuries were identified with advanced imaging compared with radiographs alone (P < 0.001). There was no statistically significant difference in rate of admission (P = 0.5) or hospital length of stay (P = 0.31) between patients with radiographs alone compared with patients evaluated with radiographs plus advanced imaging. The rate of displacement >1 cm at presentation and 6-week follow-up was unaffected by the presence of a posterior injury diagnosed on advanced imaging. Treatment for all 87 patients remained weight-bearing as tolerated with assist device irrespective of advanced imaging findings, and no patient underwent surgical intervention by 12-week follow-up.

CONCLUSIONS

Despite frequent identification of posterior pelvic ring injuries in patients evaluated with advanced imaging, admission status, length of hospital stay, radiographic displacement, and treatment recommendations were unaffected by these findings. The use of advanced imaging in elderly patients with low-energy traumatic pelvic ring fractures may not be necessary.

LEVEL OF EVIDENCE

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

对于老年患者低能量创伤所致骨盆骨折的评估，是否需要进行高级影像学检查？

设计

回顾性研究。

地点

单一机构，一级创伤中心。

患者

年龄≥60岁，因低能量创伤性骨盆环损伤接受治疗。

干预措施

无。

主要结局指标

通过高级影像学检查诊断出的骨盆后环损伤、影像学移位、入院状态、住院时间、负重状态建议的变化以及是否进行手术治疗。

结果

87例患者符合纳入标准，其中42例进行了高级影像学检查以评估骨盆后环（10例磁共振成像，32例计算机断层扫描）。与单纯X线片相比，高级影像学检查发现更多骨盆后环损伤（P < 0.001）。单纯X线片检查的患者与X线片加高级影像学检查评估的患者在入院率（P = 0.5）或住院时间（P = 0.31）方面无统计学显著差异。在初次就诊和6周随访时移位>1 cm的发生率不受高级影像学检查诊断出的后环损伤的影响。87例患者无论高级影像学检查结果如何，均根据耐受情况使用辅助装置负重，且在12周随访时无患者接受手术干预。