340 例骨盆脆性骨折患者的活动能力和死亡率。
Mobility and mortality of 340 patients with fragility fracture of the pelvis.
机构信息
Fujita Health University Hospital, Nagoya, Japan.
Japanese Red Cross Nagoya Daini Hospital Department of Orthopedics surgery, Nagoya, Aichi, Japan.
出版信息
Eur J Trauma Emerg Surg. 2021 Feb;47(1):29-36. doi: 10.1007/s00068-020-01481-3. Epub 2020 Aug 28.
PURPOSE
To investigate prognosis of patients with fragility fracture of the pelvis (FFP) treated in a single trauma unit in Japan.
METHODS
We retrospectively investigated 340 consecutive patients with FFP (40 men, 300 women; average age, 82.5 years) treated in our facility from April 2012 to April 2019. Fractures were categorized according to the Rommens classification. Patients' mechanism of injury, existence of hip implant, standing and walking abilities (using the Majeed score), and 1-year mortality rate were evaluated.
RESULTS
According to the Rommens classification, there were 84 type Ia, 2 type Ib, 24 type IIa, 78 type IIb, 51 type IIc, 40 type IIIa, 1 type IIIb, 4 type IIIc, 1 type IVa, 51 type IVb, and 3 type IVc fractures. Sixteen patients (4.7%) received surgical treatments. Twenty-eight patients (8.2%) had no memory of a traumatic event, and 61 (18%) had implants from a previous hip surgery. A total of 176 patients (52%) were followed up for ≥ 1 year, and 70 (39.8%) and 67 (38.1%) patients had recovery of standing and walking abilities, similar to those before the injury. The operative group (7/9 = 77.8%) had a higher proportion of patients who regained their standing and walking abilities at the 1-year follow-up than the conservative group. The 1-year mortality rate of the patients who could be followed for ≥ 1 year was 6.7%.
CONCLUSION
According to our data, 4.7% of patients were indicated for surgery, and only < 40% of patients were able to regain their pre-injury standing and walking abilities at 1 year after the injury. FFP may greatly affect an elderly's activities of daily living and may lead to prognosis similar to patients with proximal hip fractures. To regain the walking ability of patients with FFP, more aggressive indication of surgical treatment may be considered depending on the patient's background. Further examinations are necessary to determine the surgical indications and treatment protocol for FFP.
目的
研究在日本一家创伤中心接受治疗的骨盆脆弱性骨折（FFP）患者的预后。
方法
我们回顾性调查了 2012 年 4 月至 2019 年 4 月在我院接受治疗的 340 例连续 FFP 患者（40 例男性，300 例女性；平均年龄 82.5 岁）。根据 Rommens 分类对骨折进行分类。评估患者的损伤机制、是否存在髋关节植入物、站立和行走能力（采用 Majeed 评分）以及 1 年死亡率。
结果
根据 Rommens 分类，有 84 例 Ia 型、2 例 Ib 型、24 例 IIa 型、78 例 IIb 型、51 例 IIc 型、40 例 IIIa 型、1 例 IIIb 型、4 例 IIIc 型、1 例 IVa 型、51 例 IVb 型和 3 例 IVc 型骨折。16 例（4.7%）接受了手术治疗。28 例（8.2%）患者无创伤事件记忆，61 例（18%）有髋关节手术的植入物。共有 176 例（52%）患者随访时间≥1 年，70 例（39.8%）和 67 例（38.1%）患者恢复站立和行走能力，与受伤前相似。手术组（7/9=77.8%）在 1 年随访时恢复站立和行走能力的患者比例高于保守组。能够随访≥1 年的患者 1 年死亡率为 6.7%。
结论
根据我们的数据，4.7%的患者需要手术治疗，只有<40%的患者在受伤后 1 年能够恢复受伤前的站立和行走能力。FFP 可能严重影响老年人的日常生活活动能力，并可能导致与股骨近端骨折患者相似的预后。为了恢复 FFP 患者的行走能力，可能需要根据患者的背景更积极地考虑手术治疗的适应证。需要进一步检查以确定 FFP 的手术适应证和治疗方案。
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