Department for Trauma Surgery, University Medical Center Regensburg, Germany; Department for Psychosomatic Medicine, University Medical Center Regensburg, Germany.
Department for Trauma Surgery, University Medical Center Regensburg, Germany.
Injury. 2021 Jul;52(7):1880-1885. doi: 10.1016/j.injury.2021.04.041. Epub 2021 Apr 16.
Non-union after fracture depicts a devastating complication in trauma surgery and studies assessing patient-reported outcome measures after stable bone consolidation are rare. Therefore, we aimed to evaluate the long-term impact of aseptic long bone non-union on the patients' physical health state and psychological wellbeing. For this purpose, quality of life after successful surgical treatment of long bone non-union was assessed.
Sixty-one patients with aseptic long bone non-union surgically treated in our department between November 2009 and March 2019 with achieved bone consolidation were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data.
With a minimum follow-up time of one year after the last surgery (mean 4.7 ± 2.7 years) the mean physical health component score of the SF-36 was 38.9 ± 13.7 and the mean mental health component score of the SF-36 was 49.0 ± 5.9, indicating lower quality of life compared to German normative values of 48.4 ± 9.4 (p < .001) and 50.9 ± 8.8 (p = 1.61), respectively. The mean EQ-5D index value reached 0.827 ± 0.18 with an EQ-5D VAS rating of 64.4 ± 21.5 compared to scores of 0.922 (p < .001) and 72.9 ± 1.1 (p < .001) obtained from an age-matched reference population. Mean scores of the ISR did not reveal significant psychological symptom burden in any scale, while an individual analysis showed moderate to severe impairments in 11.5% of the patients in total.
Even 4.7 years on average after surgically successful treatment of aseptic long bone non-union, patients still report significant lower quality of life in comparison to normative data. Future clinical studies on non-unions should focus on patient-related outcome measures. Newly emerging treatment strategies and interdisciplinary approaches should be implemented to improve the overall quality of life of non-union patients.
骨折后不愈合是创伤外科中一种破坏性的并发症，评估稳定骨愈合后患者报告的结果测量指标的研究很少。因此，我们旨在评估无菌性长骨不愈合对患者身体健康状态和心理健康的长期影响。为此，评估了成功手术治疗长骨不愈合后的生活质量。
2009 年 11 月至 2019 年 3 月期间，我们科室对 61 例无菌性长骨不愈合患者进行了手术治疗，这些患者均已达到骨愈合。使用 EQ-5D 和 SF-36 结果工具以及基于 ICD-10 的症状评分（ISR）评估生活质量，并与正态数据进行比较。
末次手术后的随访时间至少为 1 年（平均 4.7±2.7 年），SF-36 的平均身体健康成分评分（PCS）为 38.9±13.7，SF-36 的平均心理健康成分评分（MCS）为 49.0±5.9，与德国 48.4±9.4（p<.001）和 50.9±8.8（p=1.61）的正态数据相比，生活质量较低。EQ-5D 指数值平均为 0.827±0.18，EQ-5D VAS 评分为 64.4±21.5，与年龄匹配的参考人群获得的 0.922（p<.001）和 72.9±1.1（p<.001）相比。ISR 的平均评分并未显示出任何量表存在显著的心理症状负担，而个别分析显示，总共有 11.5%的患者存在中度至重度损伤。
即使在无菌性长骨不愈合的手术治疗后平均 4.7 年，与正态数据相比，患者仍报告生活质量显著较低。未来的非愈合临床研究应侧重于患者相关的结果测量指标。应实施新的治疗策略和跨学科方法，以提高非愈合患者的整体生活质量。
