Ueda Yasuhisa, Inui Takahiro, Kurata Yoshiaki, Tsuji Hideki, Saito Jota, Shitan Yui
Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, Oyachi-higashi 1-1-1, Atsubetsu Ward, Sapporo, Hokkaido, 004-0041, Japan.
Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.
Eur J Trauma Emerg Surg. 2021 Apr;47(2):507-513. doi: 10.1007/s00068-019-01150-0. Epub 2019 May 20.
Most fragility fractures of the pelvis (FFPs) are conservatively treated in the early phase. However, the definition of conservative treatment failure and the subsequent treatment protocol is controversial. Fracture progression (FP) sometimes occurs during conservative treatment of FFPs. This study aimed to assess the association between FP and prolonged pain in patients with FFPs receiving conservative treatment.
Retrospective case series in a single institution in Japan. A total of 192 consecutive FFP patients were identified during study period. Seventy-nine patients met the inclusion and exclusion criteria. FFPs were diagnosed using both CT and MRI and FP was diagnosed with CT. Patients met criteria for prolonged pain if they had persisting pain after 2 weeks of conservative treatment and had lack of improvement in mobility. The relationship between FP and prolonged pain was analyzed using Fisher's exact test.
Of the 79 patients, 18 developed FP. Four of the 18 patients with FP met criteria for prolonged pain. Two of 61 patients without FP had prolonged pain (p = 0.022; odds ratio 8.12). In the entire study cohort, six patients (7.6%) met criteria prolonged pain and underwent elective surgery.
In patients with FFPs, prolonged pain was associated with FP (p = 0.022, OR 8.12). The presence of prolonged pain might help identify FP. If FP is identified, surgical treatment may be required with cautious follow-up particularly in cases, where FFP progresses to type III or IV fracture.
大多数骨盆脆性骨折（FFP）在早期采用保守治疗。然而，保守治疗失败的定义及后续治疗方案存在争议。FFP保守治疗期间有时会发生骨折进展（FP）。本研究旨在评估接受保守治疗的FFP患者中FP与持续性疼痛之间的关联。
日本一家机构的回顾性病例系列研究。研究期间共确定了192例连续的FFP患者。79例患者符合纳入和排除标准。通过CT和MRI诊断FFP，通过CT诊断FP。如果患者在保守治疗2周后仍有持续疼痛且活动能力无改善，则符合持续性疼痛标准。使用Fisher精确检验分析FP与持续性疼痛之间的关系。
79例患者中，18例发生了FP。18例发生FP的患者中有4例符合持续性疼痛标准。61例未发生FP的患者中有2例有持续性疼痛（p = 0.022；优势比8.12）。在整个研究队列中，6例患者（7.6%）符合持续性疼痛标准并接受了择期手术。
在FFP患者中，持续性疼痛与FP相关（p = 0.022，OR 8.12）。持续性疼痛的存在可能有助于识别FP。如果识别出FP，可能需要进行手术治疗，并谨慎随访，尤其是在FFP进展为III型或IV型骨折的情况下。
