Cochran T P, Bayley J C, Smith M
Section of Orthopaedic Surgery, West Roxbury VA Medical Center, Harvard Medical School, Massachusetts.
J Spinal Disord. 1988;1(3):219-23.
Eighty-seven lower extremity fractures in 71 paraplegics were retrospectively evaluated to determine adequacy of treatment, functional result, and range of motion of the hip and knee. Most fractures treated closed healed without difficulty, but with a complication rate of 19%. Length of hospitalization averaged almost 3 months in the group treated closed, and residual hip and knee stiffness was the major complication. This was not a problem except in high demand patients, such as wheelchair athletes, in whom decreased range of motion was a significant limitation. Treatment with circular casts produced a high number of complications and is not recommended for patients with insensate skin. Open reduction and internal fixation is recommended for a small subgroup of paraplegics: wheelchair athletes, hip fractures, and those in whom autonomic dysreflexia and/or uncontrollable spasticity due to fracture manipulation is a significant hazard.
对71例截瘫患者的87处下肢骨折进行回顾性评估，以确定治疗的充分性、功能结果以及髋部和膝部的活动范围。大多数闭合治疗的骨折顺利愈合，但并发症发生率为19%。闭合治疗组的平均住院时间近3个月，髋部和膝部残留僵硬是主要并发症。除了对活动需求较高的患者（如轮椅运动员）外，这并非问题，因为活动范围减小对他们来说是一个重大限制。环形石膏治疗会产生大量并发症，不建议用于皮肤感觉缺失的患者。对于一小部分截瘫患者建议进行切开复位内固定：轮椅运动员、髋部骨折患者以及因骨折操作导致自主神经反射异常和/或无法控制的痉挛是重大风险的患者。
