Castillo Renan C, Carlini Anthony R, Doukas William C, Hayda Roman A, Frisch Harold M, Andersen Romney C, D'Alleyrand Jean-Claude, Mazurek Michael T, Ficke James R, Keeling John J, Pasquina Paul F, Wain Harold J, MacKenzie Ellen J
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
UHC Orthopedics, Bridgeport, WV.
J Orthop Trauma. 2021 Mar 1;35(3):e96-e102. doi: 10.1097/BOT.0000000000001921.
Assess the burden and co-occurrence of pain, depression, and posttraumatic stress disorder (PTSD) among service members who sustained a major limb injury, and examine whether these conditions are associated with functional outcomes.
A retrospective cohort study.
Four U.S. military treatment facilities: Walter Reed Army Medical Center, National Naval Medical Center, Brooke Army Medical Center, and Naval Medical Center San Diego.
PATIENTS/PARTICIPANTS: Four hundred twenty-nine United States service members who sustained a major limb injury while serving in Afghanistan or Iraq met eligibility criteria upon review of their medical records.
Not applicable.
Outcomes assessed were: function using the short musculoskeletal functional assessment; PTSD using the PTSD Checklist and diagnostic and statistical manual criteria; pain using the chronic pain grade scale.
Military extremity trauma and amputation/limb salvage patients without pain, depression, or PTSD, were, on average, about one minimally clinically important difference (MCID) from age- and gender-adjusted population norms. In contrast, patients with low levels of pain and no depression or PTSD were, on average, one to 2 MCIDs from population norms. Military extremity trauma and amputation/limb salvage patients with either greater levels of pain, and who experience PTSD, depression, or both, were 4 to 6 MCIDs from population norms. Regression analyses adjusting for injury type (upper or lower limb, salvage or amputation, and unilateral or bilateral), age, time to interview, military rank, presence of a major upper limb injury, social support, presence of mild traumatic brain injury/concussion, and combat experiences showed that higher levels of pain, depression, and PTSD were associated with lower one-year functional outcomes.
Major limb trauma sustained in the military results in significant long-term pain and PTSD. Overall, the results are consistent with the hypothesis that pain, depression, and PTSD are associated with disability in this population.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估遭受严重肢体损伤的军人中疼痛、抑郁和创伤后应激障碍（PTSD）的负担及共病情况，并研究这些状况是否与功能结局相关。
一项回顾性队列研究。
美国四个军事治疗机构：沃尔特里德陆军医疗中心、国家海军医疗中心、布鲁克陆军医疗中心和圣地亚哥海军医疗中心。
患者/参与者：429名在阿富汗或伊拉克服役期间遭受严重肢体损伤的美国军人，经病历审查符合纳入标准。
不适用。
评估的结局包括：使用简短肌肉骨骼功能评估法评估功能；使用PTSD检查表及诊断和统计手册标准评估PTSD；使用慢性疼痛分级量表评估疼痛。
无疼痛、抑郁或PTSD的军事肢体创伤及截肢/肢体保全患者，与年龄和性别调整后的人群规范相比，平均相差约一个最小临床重要差异（MCID）。相比之下，疼痛程度低且无抑郁或PTSD的患者，与人群规范相比平均相差1至2个MCID。患有更严重疼痛且伴有PTSD、抑郁或两者皆有的军事肢体创伤及截肢/肢体保全患者，与人群规范相比相差4至6个MCID。针对损伤类型（上肢或下肢、保全或截肢、单侧或双侧）、年龄、访谈时间、军衔、是否存在主要上肢损伤、社会支持、是否存在轻度创伤性脑损伤/脑震荡以及战斗经历进行回归分析，结果显示，疼痛、抑郁和PTSD程度较高与一年后的功能结局较差相关。
军事行动中遭受的严重肢体创伤会导致长期的显著疼痛和PTSD。总体而言，研究结果与疼痛、抑郁和PTSD与该人群残疾相关的假设一致。
预后性证据级别III。有关证据级别的完整描述，请参阅作者须知。
