老年患者高能量与低能量髋臼骨折的调查
A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients.
作者信息
Dyskin Evgeny, Hill Brian W, Torchia Michael T, Cole Peter A
机构信息
Department of Orthopaedics, University at Buffalo, NY, USA.
Department of Orthopaedic Surgery, Saint Louis University, MO, USA.
出版信息
Geriatr Orthop Surg Rehabil. 2019 Aug 20;10:2151459319870426. doi: 10.1177/2151459319870426. eCollection 2019.
INTRODUCTION
Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury.
METHODS
Patients (≥65 years of age) diagnosed with an acetabular fracture were identified over a 7-year period. Patient and injury characteristics were extracted from our institutional trauma database. Length of stay, intervention, operative details, disposition, complications, readmissions, and mortality were analyzed.
RESULTS
One hundred nine patients were identified for inclusion. Low-energy mechanisms (simple falls) were found in 64 (58.7%) and HE mechanisms in 45 (41.3%) patients. The HE cohort was younger (74.6 vs 80.7 years; < .001), had a higher male predominance (76% vs 56%; = .10), a lower Charlson comorbidity index (1.29 ± 1.49 vs 2.16 ± 1.76; = .01), and a higher injury severity score (19.90 ± 15.33 vs 6.46 ± 3.57; < .001). Fracture patterns, described according to the Letournel-Judet classification, were similar between the 2 groups. Thirty-day mortality was significantly higher in the HE group (26.7% vs 3.1%; < .001); however, the 1-year mortality rates were not statistically different (31.1% vs 25.0%; P = .20).
DISCUSSION
Patients with acetabular fractures sustained due to HE accidents demonstrate significantly higher 30-day mortality rate than patients with low-energy fractures, but similar mortality 1 year after the injury, despite having a much lower mean age and fewer comorbidities.
CONCLUSION
Medical efforts made during initial hospital admission may have the biggest impact on survivorship following acetabular fracture.
引言
老年患者占髋臼骨折患者的14%，且是美国受此类损伤影响的患者中增长最快的亚组。据报道，高能（HE）髋臼创伤后老年患者的治疗效果不如年轻患者。本研究旨在比较北美一家三级创伤中心治疗的老年患者（≥65岁）在高能量和低能量损伤机制导致髋臼骨折后的详细人口统计学特征和临床结局。
方法
在7年期间识别出诊断为髋臼骨折的患者（≥65岁）。从我们机构的创伤数据库中提取患者和损伤特征。分析住院时间、干预措施、手术细节、处置情况、并发症、再入院情况和死亡率。
结果
确定109例患者纳入研究。64例（58.7%）患者为低能量机制（单纯跌倒），45例（41.3%）患者为高能机制。高能组患者年龄较轻（74.6岁对80.7岁；P<.001），男性占比更高（76%对56%；P =.10），Charlson合并症指数更低（1.29±1.49对2.16±1.76；P =.01），损伤严重程度评分更高（19.90±15.33对6.46±3.57；P<.001）。根据Letournel-Judet分类描述的骨折类型在两组之间相似。高能组30天死亡率显著更高（26.7%对3.1%；P<.001）；然而，1年死亡率无统计学差异（31.1%对25.0%；P =.20）。
讨论
高能事故导致髋臼骨折的患者30天死亡率显著高于低能量骨折患者，但受伤1年后死亡率相似，尽管前者平均年龄低得多且合并症较少。
结论
初次住院期间的医疗努力可能对髋臼骨折后的生存率产生最大影响。
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