Verma Vishal, Sen Ramesh Kumar, Tripathy Sujit Kumar, Aggarwal Sameer, Sharma Suresh
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Dept. of Orthopaedics, Max Hospital, Mohali, Chandigarh, India.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1016-1024. doi: 10.1016/j.jcot.2020.08.011. Epub 2020 Sep 1.
Functional outcome and health-related quality of life (HRQOL) after pelvis fracture is suboptimal; majority of the patients do not return to their preinjury activities. Many researchers reported that late morbidity in pelvis fracture is associated with severity of the fracture, associated trauma, pelvic fracture-related complications and methods of treatment.
One hundred and twelve patients with pelvis fracture who were treated either conservatively (n = 88) or surgically (n = 24) with a minimum of two years follow up were evaluated clinically and radiologically. The clinical outcome was evaluated using Majeed score and self-reported Short Musculoskeletal Function Assessment (SMFA). Their HRQOL was evaluated using the 36-item Short Form Survey (SF-36) and WHOQOL-BREF questionnaires. The fracture-displacement in the anterior or posterior pelvis ring was measured from the anteroposterior radiograph or inlet/outlet view.
The average Majeed score was 76.65 ± 14.73 (range, 36 to 96). There were 81 patients with good to excellent outcomes and 31 patients with poor to fair outcomes. The average SF-36 Physical Component Summary (PCS) score was 47.71 ± 7.88 (range, 27.3 to 61.5) and SF-36 Mental Component Summary (MCS) was 49.20 ± 9.37 (range, 23.1 to 56.8). The functional level of the general population in the physical and mental domain was achieved in 48.23% and 65.3% of pelvic-fractured patients respectively. General population norms were achieved in 56.3%, 63.4%, 65.2% and 84.8% of patients in WHOQOL-BREF domain one, two, three and four respectively. The patients had significantly worse functional outcome and HRQOL if residual displacement was > 1 cm. Age, sex, associated injuries and injury mechanism were not affecting the HRQOL in patients with acceptable residual displacement of ≤ 1 cm.
Pelvic fracture with the residual displacement of ≤ 1 cm in the sacroiliac joint/symphysis pubis result in better functional outcome and HRQOL. Injury mechanism and associated injury have no impact on the HRQOL if the residual displacement is within the acceptable limit.
骨盆骨折后的功能结局及与健康相关的生活质量（HRQOL）并不理想；大多数患者无法恢复到受伤前的活动水平。许多研究人员报告称，骨盆骨折的晚期发病率与骨折严重程度、合并创伤、骨盆骨折相关并发症及治疗方法有关。
对112例骨盆骨折患者进行了临床和影像学评估，这些患者接受了保守治疗（n = 88）或手术治疗（n = 24），且随访时间至少为两年。使用马吉德评分（Majeed score）和自我报告的简短肌肉骨骼功能评估（SMFA）评估临床结局。使用36项简明健康调查问卷（SF - 36）和世界卫生组织生活质量简表（WHOQOL - BREF）问卷评估他们的HRQOL。通过前后位X线片或入口/出口位片测量骨盆前环或后环的骨折移位情况。
马吉德评分的平均值为76.65±14.73（范围为36至96）。81例患者结局良好至优秀，31例患者结局较差至中等。SF - 36身体成分总结（PCS）评分的平均值为47.71±7.88（范围为27.3至61.5），SF - 36心理成分总结（MCS）评分为49.20±9.37（范围为23.1至56.8）。骨盆骨折患者在身体和心理领域分别达到一般人群功能水平的比例为48.23%和65.3%。在WHOQOL - BREF领域一、二、三、四中，分别有56.3%、63.4%、65.2%和84.8%的患者达到一般人群标准。如果残留移位>1 cm，患者的功能结局和HRQOL明显更差。对于残留移位≤1 cm且可接受的患者，年龄、性别、合并损伤和损伤机制不影响HRQOL。
骶髂关节/耻骨联合处残留移位≤1 cm的骨盆骨折导致更好的功能结局和HRQOL。如果残留移位在可接受范围内，损伤机制和合并损伤对HRQOL没有影响。
