Sprague Sheila, Heels-Ansdell Diane, Bzovsky Sofia, Zdero Radovan, Bhandari Mohit, Swiontkowski Marc, Tornetta Paul, Sanders David, Schemitsch Emil
Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Hamilton, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Bone Jt Open. 2021 Jan 5;2(1):22-32. doi: 10.1302/2633-1462.21.BJO-2020-0150.R1. eCollection 2021 Jan.
Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery.
The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p < 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL.
For patient and surgical factors, only pre-injury quality of life and isolated fracture showed a statistical effect on all four HRQoL outcomes, while high-energy injury mechanism, smoking, and race or ethnicity, demonstrated statistical significance for three of the four HRQoL outcomes. Patients who did not require reoperation in response to infection, the need for bone grafts, and/or the need for implant exchanges had statistically superior HRQoL outcomes than those who did require intervention within one year after initial tibial fracture nailing.
We identified several baseline patient factors, surgical factors, and post-intervention procedures within one year after intramedullary nailing of a tibial shaft fracture that may influence a patient's HRQoL.Cite this article: 2021;2(1):22-32.
利用一项大型多中心随机对照试验中胫骨干骨折的参与者，我们调查了患者和手术因素是否与术后一年的健康相关生活质量（HRQoL）相关。
前瞻性评估胫骨干骨折患者扩髓髓内钉的研究（SPRINT）试验，对开放性或闭合性胫骨干骨折的成年人进行了研究，这些患者接受了扩髓或非扩髓髓内钉治疗。使用短肌肉骨骼功能评估（SMFA）功能障碍、SMFA困扰、36项简短健康调查问卷（SF-36）身体和SF-36心理成分得分，在出院时（用于评估受伤前水平）和骨折后12个月评估HRQoL。我们使用多元线性回归分析来确定基线和手术因素，以及骨折后一年内的干预后程序，是否与这些HRQoL结果相关。显著性设定为p<0.01。我们假设，无论使用哪四种测量方法，预后都由可改变和不可改变的因素共同指导，并且患者不会恢复到受伤前的功能水平或HRQoL。
对于患者和手术因素，只有受伤前的生活质量和单纯骨折对所有四项HRQoL结果有统计学影响，而高能量损伤机制、吸烟以及种族或民族，对四项HRQoL结果中的三项具有统计学意义。因感染、需要植骨和/或需要更换植入物而不需要再次手术的患者，其HRQoL结果在统计学上优于初次胫骨干骨折钉固定后一年内确实需要干预的患者。
我们确定了胫骨干骨折髓内钉固定后一年内的几个基线患者因素·手术因素和干预后程序，这些因素可能会影响患者的HRQoL。引用本文：2021；2(1)::22-32。
