髓内钉固定后胫骨干骨折的短期和长期恢复轨迹

Trajectory of Short- and Long-Term Recovery of Tibial Shaft Fractures After Intramedullary Nail Fixation.

作者信息

Ko Sebastian J, OʼBrien Peter J, Guy Pierre, Broekhuyse Henry M, Blachut Piotr A, Lefaivre Kelly A

机构信息

Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.

出版信息

J Orthop Trauma. 2017 Oct;31(10):559-563. doi: 10.1097/BOT.0000000000000886.

DOI:10.1097/BOT.0000000000000886

PMID:28538288

Abstract

OBJECTIVE

To determine the trajectory of recovery after tibial shaft fracture treated with intramedullary nail over the first 5 years and to evaluate the magnitude of the changes in functional outcome at various time intervals.

DESIGN

Prospective cohort study.

SETTING

A Level 1 trauma center.

PATIENTS/PARTICIPANTS: One hundred thirty-two patients with tibial shaft fracture (OTA 42-A, B, C) were enrolled into the Center's prospective orthopaedic trauma database between January 2005 and February 2010. Functional outcome data were collected at baseline, 6 months, 1 year, and 5 years.

INTERVENTION

Enrolled patients were treated acutely with intramedullary nailing of their tibia.

MAIN OUTCOME MEASUREMENTS

Evaluation was performed using the Short Form-36 and Short Musculoskeletal Function Assessment (SMFA).

RESULTS

Mean SF-36 physical component scores improved between 6 and 12 months (P = 0.0008) and between 1 and 5 years (P = 0.0029). Similarly, mean SMFA dysfunction index scores improved between 6 and 12 months (P = 0.0254) and between 1 and 5 years (P = 0.0106). In both scores, the rate or slope of this improvement is flatter between 1 and 5 years than it is between 6 and 12 months. Furthermore, SF-36 and SMFA scores did not reach baseline at 5 years (SF-36 P < 0.0001, SMFA P = 0.0026). A significant proportion of patients were still achieving a minimal clinically important difference in function between 1 and 5 years (SF-36 = 54%, SMFA = 44%).

CONCLUSIONS

The trajectory of functional recovery after tibial shaft fracture is characterized by an initial decline in function, followed by improvement between 6 and 12 months. There is still further improvement beyond 1 year, but this is of flatter trajectory. The 5-year results indicate that function does not improve to baseline by 5 years after injury.

LEVEL OF EVIDENCE

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

摘要

目的

确定髓内钉治疗胫骨干骨折后最初5年的恢复轨迹，并评估不同时间间隔功能结局变化的程度。

设计

前瞻性队列研究。

地点

一级创伤中心。

患者/参与者：2005年1月至2010年2月期间，132例胫骨干骨折（OTA 42-A、B、C型）患者被纳入该中心的前瞻性骨科创伤数据库。在基线、6个月、1年和5年时收集功能结局数据。

干预

纳入的患者接受胫骨急性髓内钉固定治疗。

主要结局测量

使用简明健康调查36项量表（Short Form-36，SF-36）和简短肌肉骨骼功能评估（Short Musculoskeletal Function Assessment，SMFA）进行评估。

结果

SF-36身体成分评分在6至12个月之间（P = 0.0008）以及1至5年之间（P = 0.0029）有所改善。同样，SMFA功能障碍指数评分在6至12个月之间（P = 0.0254）以及1至5年之间（P = 0.0106）有所改善。在这两个评分中，1至5年期间这种改善的速率或斜率比6至12个月期间更平缓。此外，5年时SF-36和SMFA评分未恢复到基线水平（SF-36 P < 0.0001，SMFA P = 0.0026）。相当一部分患者在1至5年期间功能仍有最小临床重要差异（SF-36 = 54%，SMFA = 44%）。