国家创伤数据库中25615例距骨骨折患者的人口统计学特征、损伤机制及相关损伤情况
Demographics, mechanism of injury, and associated injuries of 25,615 patients with talus fractures in the National Trauma Data Bank.
作者信息
Anandasivam Nidharshan S, Bagi Paul, Ondeck Nathaniel T, Galivanche Anoop R, Kuzomunhu Lovemore S, Samuel Andre M, Bohl Daniel D, Grauer Jonathan N
机构信息
Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 47 College Street, New Haven, CT, 06510, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70St., New York, NY, 10021, USA.
出版信息
J Clin Orthop Trauma. 2020 May-Jun;11(3):426-431. doi: 10.1016/j.jcot.2019.06.007. Epub 2019 Jun 8.
BACKGROUND
Extensive research has been conducted concerning the epidemiology of fractures of the calcaneus and ankle. However, less work has characterized the population sustaining talus fractures, necessitating the analysis of a large, national sample to assess the presentation of this important injury.
METHODS
The current study included adult patients from the 2011 through 2015 National Trauma Data Bank (NTDB) who had talus fractures. Modified Charlson Comorbidity Index (CCI), mechanism of injury (MOI), Injury Severity Score (ISS), and associated injuries were evaluated.
RESULTS
Out of 25,615 talus fracture patients, 15,607 (61%) were males. The age distribution showed a general decline in frequency as age increased after a peak incidence at 21 years of age. As expected, CCI increased as age increased. The mechanism of injury analysis showed a decline in motor vehicle accidents (MVAs) and an increase in falls as age increased. ISS was generally higher for MVAs compared to falls and other injuries.Overall, 89% of patients with a talus fracture had an associated injury. Among associated bony injuries, non-talus lower extremity fractures were common, with ankle fractures (noted in 42.7%) and calcaneus fractures (noted in 27.8%) being the most notable. The most common associated internal organ injuries were lung (noted in 19.0%) and intracranial injuries (noted in 14.9%).
CONCLUSION
This large cohort of patients with talus fractures defined the demographics of those who sustain this injury and demonstrated ankle and calcaneus fractures to be the most commonly associated injuries. Other associated orthopaedic and non-orthopaedic injuries were also defined. In fact, the incidence of associated lumbar spine fracture was similar to that seen for calcaneus fractures (14%) and nearly 1 in 5 patients had a thoracic organ injury. Clinicians need to maintain a high suspicion for such associated injuries for those who present with talus fractures.
LEVEL OF EVIDENCE
Level II, retrospective study.
背景
关于跟骨和踝关节骨折的流行病学已经开展了广泛研究。然而，针对距骨骨折人群特征的研究较少，因此有必要分析一个大型全国性样本，以评估这种重要损伤的表现。
方法
本研究纳入了2011年至2015年国家创伤数据库（NTDB）中的成年距骨骨折患者。评估了改良查尔森合并症指数（CCI）、损伤机制（MOI）、损伤严重程度评分（ISS）及相关损伤情况。
结果
在25615例距骨骨折患者中，15607例（61%）为男性。年龄分布显示，在21岁达到发病率峰值后，随着年龄增长频率总体呈下降趋势。正如预期的那样，CCI随年龄增长而增加。损伤机制分析表明，随着年龄增长，机动车事故（MVA）减少，跌倒增加。与跌倒及其他损伤相比，MVA患者的ISS通常更高。总体而言，89%的距骨骨折患者伴有相关损伤。在相关骨损伤中，非距骨下肢骨折很常见，其中踝关节骨折（占42.7%）和跟骨骨折（占27.8%）最为显著。最常见的相关内脏器官损伤是肺部损伤（占19.0%）和颅内损伤（占14.9%）。
结论
这个大型距骨骨折患者队列明确了遭受这种损伤人群的人口统计学特征，并表明踝关节和跟骨骨折是最常见的相关损伤。还明确了其他相关的骨科和非骨科损伤。事实上，相关腰椎骨折的发生率与跟骨骨折相似（14%），近五分之一的患者有胸部器官损伤。临床医生对于出现距骨骨折的患者，需要高度怀疑此类相关损伤。
证据水平
二级，回顾性研究。
Zotero 插件