OTA/AO分类对胫骨骨折后急性骨筋膜室综合征具有高度预测性：2885例骨折队列研究

OTA/AO Classification Is Highly Predictive of Acute Compartment Syndrome After Tibia Fracture: A Cohort of 2885 Fractures.

作者信息

Beebe Michael J, Auston Darryl A, Quade Jonathan H, Serrano-Riera Rafael, Shah Anjan R, Watson David T, Sanders Roy W, Mir Hassan R

机构信息

*Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN; †Hughston Trauma at Orange Park Medical Center, Orange Park, FL; ‡Division of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL; §Department of Orthopaedic Surgery, University of South Florida, Tampa, FL; and ‖Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL.

出版信息

J Orthop Trauma. 2017 Nov;31(11):600-605. doi: 10.1097/BOT.0000000000000918.

DOI:10.1097/BOT.0000000000000918

PMID:28614149

Abstract

OBJECTIVE

To determine the correlation between the OTA/AO classification of tibia fractures and the development of acute compartment syndrome (ACS).

DESIGN

Retrospective review of prospectively collected database.

SETTING

Single Level 1 academic trauma center.

PATIENTS

All patients with a tibia fracture from 2006 to 2016 were reviewed for this study. Three thousand six hundred six fractures were initially identified. Skeletally mature patients with plate or intramedullary fixation managed from initial injury through definitive fixation at our institution were included, leaving 2885 fractures in 2778 patients.

METHODS

After database and chart review, univariate analyses were conducted using independent t tests for continuous data and χ tests of independence for categorical data. A simultaneous multivariate binary logistic regression was developed to identify variables significantly associated with ACS.

RESULTS

ACS occurred in 136 limbs (4.7%). The average age was 36.2 years versus 43.3 years in those without (P < 0.001). Men were 1.7 times more likely to progress to ACS than women (P = 0.012). Patients who underwent external fixation were 1.9 times more likely to develop ACS (P = 0.003). OTA/AO 43 injuries were at least 4.0 times less likely to foster ACS versus OTA/AO 41 or 42 injuries (P < 0.007). OTA/AO 41-C injuries were 5.5 times more likely to advance to ACS compared with OTA/AO 41-A (P = 0.03). There was a significantly higher rate of ACS in OTA/AO 42-B (P = 0.005) and OTA/AO 42-C (P = 0.002) fractures when compared with OTA/AO 42-A fractures. In the distal segment, fracture type did not predict the risk of ACS (P > 0.15). Group 1 fractures had a lower rate of ACS compared with group 2 (P = 0.03) and group 3 (P = 0.003) fractures in the middle segment only. Bilateral tibia fractures had a 2.7 times lower rate of ACS (P = 0.04). Open injury, multiple segment injury, fixation type, and concurrent pelvic or femoral fractures did not predict ACS.

CONCLUSIONS

In this large cohort of tibia fractures, we found that the age, sex, and OTA/AO classification were highly predictive for the development of ACS.

LEVEL OF EVIDENCE

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

摘要

目的

确定胫骨骨折的OTA/AO分类与急性骨筋膜室综合征（ACS）发生之间的相关性。

设计

对前瞻性收集的数据库进行回顾性分析。

地点

单一的一级学术创伤中心。

患者

对2006年至2016年所有胫骨骨折患者进行本研究回顾。最初识别出3606例骨折。纳入在我们机构接受从初始损伤到确定性固定治疗的骨骼成熟且采用钢板或髓内固定的患者，最终纳入2778例患者的2885处骨折。

方法

在对数据库和病历进行回顾后，对连续数据使用独立t检验、对分类数据使用χ²独立性检验进行单因素分析。开展多变量二元逻辑回归分析以识别与ACS显著相关的变量。

结果

136例肢体（4.7%）发生ACS。发生ACS患者的平均年龄为36.2岁，未发生ACS患者的平均年龄为43.3岁（P < 0.001）。男性进展为ACS的可能性是女性的1.7倍（P = 0.012）。接受外固定治疗的患者发生ACS的可能性是未接受外固定治疗患者的1.9倍（P = 0.003）。与OTA/AO 41或42型损伤相比，OTA/AO 43型损伤发生ACS的可能性至少低4.0倍（P < 0.007）。与OTA/AO 41-A型损伤相比，OTA/AO 41-C型损伤进展为ACS的可能性高5.5倍（P = 0.03）。与OTA/AO 42-A型骨折相比，OTA/AO 42-B型（P = 0.005）和OTA/AO 42-C型（P = 0.002）骨折发生ACS的概率显著更高。在远端节段，骨折类型不能预测ACS风险（P > 0.15）。仅在中段，1组骨折发生ACS的概率低于2组（P = 0.03）和3组（P = 0.003）骨折。双侧胫骨骨折发生ACS的概率低2.7倍（P = 0.04）。开放性损伤、多节段损伤、固定类型以及并发骨盆或股骨骨折不能预测ACS。