Sharpe John P, Magnotti Louis J, Gobbell Wade C, Huang Xin, Perez Edward A, Fabian Timothy C, Croce Martin A
From the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
J Trauma Acute Care Surg. 2017 Mar;82(3):444-450. doi: 10.1097/TA.0000000000001346.
Traumatic disruption of the pelvic ring is a significant cause of life-threatening hemorrhage. For those patients who survive the initial injury, these fractures are associated with long periods of immobilization and intense rehabilitation. There is little published information available regarding long-term functional outcomes in these patients. This study evaluated the impact of severe pelvic fractures on those long-term outcomes.
All patients with severe pelvic fractures over an 18-year period were identified. Severe pelvic fractures were defined as those with vascular disruption, open-book component with symphysis diastasis, or sacroiliac disruption with vertical shear. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care to assess mobility (normal, >84) and daily activity (normal, >84). Multiple linear regression analysis was used to identify predictors of functional outcome after severe pelvic fracture.
From January 1996 to September 2014, 401 patients were identified: 240 (60%) men and 161 (40%) women. Overall mortality was 29%. Of the 285 survivors, follow-up was obtained in 145 patients (51%). Mean follow-up was 8.3 years, with a maximum of 20 years. Mean age and Injury Severity Score were 53 years and 27, respectively. Mean Activity Measure for Post-Acute Care scores for mobility and daily activity were 55 and 63, respectively; both signifying significant impairment when compared with normal. Multiple linear regression analysis using age, traumatic brain injury, transfusions, Injury Severity Score, ventilator days, presence of associated lower-extremity fractures, and time to operative pelvic fixation identified time to pelvic fixation as the only predictor of decreased mobility (β = -0.74, p = 0.04) and activity (β = -0.21, p = 0.03) following severe pelvic fracture.
Prolonged time to operative pelvic fixation led to worse long-term functional outcomes in patients with severe pelvic ring disruption. Early fixation of the pelvic ring is the only potentially modifiable risk factor for decreased functional outcomes in patients with severe pelvic fractures.
Therapeutic study, level IV.
骨盆环创伤性断裂是危及生命的出血的重要原因。对于那些在初始损伤中幸存下来的患者，这些骨折与长期固定和强化康复相关。关于这些患者的长期功能结局，几乎没有公开的信息。本研究评估了严重骨盆骨折对这些长期结局的影响。
确定了18年间所有患有严重骨盆骨折的患者。严重骨盆骨折定义为伴有血管破裂、耻骨联合分离的开书型骨折或伴有垂直剪切力的骶髂关节断裂。使用波士顿大学急性后期护理活动量表来测量功能结局，以评估活动能力（正常，>84）和日常活动（正常，>84）。采用多元线性回归分析来确定严重骨盆骨折后功能结局的预测因素。
从1996年1月至2014年9月，共确定了401例患者：男性240例（60%），女性161例（40%）。总体死亡率为29%。在285名幸存者中，对145例患者（51%）进行了随访。平均随访时间为8.3年，最长为20年。平均年龄和损伤严重程度评分分别为53岁和27分。急性后期护理活动量表中活动能力和日常活动的平均得分分别为55分和63分；与正常情况相比，两者均表明存在显著损伤。使用年龄、创伤性脑损伤、输血次数（输血）、损伤严重程度评分、呼吸机使用天数、是否存在相关下肢骨折以及骨盆手术固定时间进行多元线性回归分析，结果表明骨盆固定时间是严重骨盆骨折后活动能力下降（β = -0.74，p = 0.04）和日常活动能力下降（β = -0.21，p = 0.03）的唯一预测因素。
骨盆手术固定时间延长导致严重骨盆环断裂患者的长期功能结局更差。骨盆环的早期固定是严重骨盆骨折患者功能结局下降的唯一潜在可改变风险因素。
治疗性研究，IV级。
