Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Study performed at MetroHealth Medical Center, an affiliate of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Injury. 2021 Jun;52(6):1396-1402. doi: 10.1016/j.injury.2020.11.027. Epub 2020 Nov 16.
Recent large series of patient-reported outcomes after acetabulum fracture are limited, and potentially modifiable risk factors may be unidentified. The goal of this study was to describe patient and injury factors which negatively influence functional outcomes following operative management of acetabular fractures.
699 patients with acetabular fractures were treated with open reduction and internal fixation (ORIF). Musculoskeletal Function Assessment (MFA) questionnaire was completed after a minimum 12 months post-injury by 283 adults. MFA scores range from 1 to 100 and higher scores represent greater dysfunction. Factors were assessed for potential association with MFA scores, and univariate and multiple linear regression analyses were performed.
Survey respondents were more severely injured than non-respondents, with more chest injury (38% vs 22%, p<0.001) and higher Injury Severity Score (19.3 vs 16.8, p=0.003). Patients were 69% male with mean age 44.0 years. Approximately one-third were smokers (31%), while 14% had comorbid diabetes mellitus type II. The majority of injuries occurred during a motor vehicle collision (65%); low-energy mechanisms were rare (4.2%). The most common fracture pattern was isolated posterior wall (23%), followed by transverse/posterior wall (21%). Heterotopic ossification (HO) was noted in 22%: Brooker 1: 29.5%, 2: 23.0%, 3: 32.8%, and 4: 14.8%. Tobacco use (β = 18.4, p<0.001), obesity (β = 0.39, p=0.009), diabetes (β = 8.2, p=0.029), post-traumatic arthrosis (PTA) (β = 5.94 p=0.035), and increasing HO severity (β = 8.93, p<0.001) were independently associated with worse MFA scores. Tobacco use had the strongest association, followed by the severity of HO.
In a large series of patient-reported functional outcomes following fixation of acetabular fractures, tobacco use, obesity, comorbid diabetes, PTA, and HO were associated with worse MFA scores. Further study to mitigate HO should be considered.
III.
最近有大量关于髋臼骨折患者报告的结局的研究，但仍存在潜在的可修正的风险因素。本研究的目的是描述影响髋臼骨折术后功能结局的患者和损伤相关因素。
699 例髋臼骨折患者接受切开复位内固定术（ORIF）治疗。283 名成年人在受伤后至少 12 个月完成了肌肉骨骼功能评估（MFA）问卷。MFA 评分范围为 1 至 100 分，得分越高表示功能障碍越严重。评估了各种因素与 MFA 评分的潜在关联，并进行了单变量和多变量线性回归分析。
调查对象比未调查对象损伤更严重，胸部损伤更多（38%比 22%，p<0.001），损伤严重程度评分更高（19.3 比 16.8，p=0.003）。患者中 69%为男性，平均年龄 44.0 岁。约三分之一的人吸烟（31%），14%的人患有 2 型糖尿病。大多数损伤发生在机动车碰撞中（65%）；低能量机制很少见（4.2%）。最常见的骨折模式是单纯后壁（23%），其次是横断/后壁（21%）。异位骨化（HO）发生率为 22%：布克 1 级：29.5%，2 级：23.0%，3 级：32.8%，4 级：14.8%。吸烟（β=18.4，p<0.001）、肥胖（β=0.39，p=0.009）、糖尿病（β=8.2，p=0.029）、创伤后关节炎（PTA）（β=5.94，p=0.035）和 HO 严重程度增加（β=8.93，p<0.001）与较差的 MFA 评分独立相关。吸烟的相关性最强，其次是 HO 的严重程度。
在一项关于髋臼骨折固定术后患者报告的功能结局的大型系列研究中，吸烟、肥胖、合并糖尿病、PTA 和 HO 与较差的 MFA 评分相关。应进一步研究以减轻 HO。
III 级。
