van der Vliet Quirine M J, Ochen Yassine, McTague Michael F, Weaver Michael J, Hietbrink Falco, Houwert Roderick M, Leenen Luke P H, Heng Marilyn
Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital.
Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, MA.
OTA Int. 2019 Nov 22;2(4):e043. doi: 10.1097/OI9.0000000000000043. eCollection 2019 Dec.
Aims of the present study were to establish generalizable outcome data on long-term functional outcomes and health-related quality of life (HRQoL) after operative treatment of pilon fractures on a large scale. Second, it was aimed to examine factors associated with these outcomes.
Retrospective cohort study with follow-up by questionnaire.
Two level 1 trauma centers.
Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%).
Open reduction internal fixation for tibial pilon fracture.
Ankle function measured using the Foot and Ankle Ability Measure, physical function using the Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire and HRQoL using the EuroQol 5-Dimensions 3-Level (EQ-5D-3L) questionnaire.
At a medium follow-up of 82 months (82 (interquartile range (IQR), 45-120), median Foot and Ankle Ability Measure was 74 (IQR, 57-82), median PROMIS PF 49 (IQR, 44-57), median EQ-5D-3L 0.81 (IQR, 0.71-0.84). HRQoL was significantly lower compared to a reference population ( < .001). In multivariable regression analyses, smoking was associated with poorer HRQoL. Higher body mass index, deep infection, and lower HRQoL were associated with worse ankle function.
Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context.
Prognostic level III.
本研究的目的是大规模建立有关pilon骨折手术治疗后长期功能结局和健康相关生活质量（HRQoL）的可推广结局数据。其次，旨在研究与这些结局相关的因素。
通过问卷调查进行随访的回顾性队列研究。
两个一级创伤中心。
480名符合条件的患者中有225名完成了调查（回复率47%）。
胫骨pilon骨折切开复位内固定术。
使用足踝能力测量量表测量踝关节功能，使用患者报告结局测量系统身体功能（PROMIS PF，简表10a）问卷测量身体功能，使用欧洲五维度健康量表3级（EQ-5D-3L）问卷测量HRQoL。
在平均82个月的随访期（82（四分位间距（IQR），45 - 120）），足踝能力测量量表的中位数为74（IQR，57 - 82），PROMIS PF的中位数为49（IQR，44 - 57），EQ-5D-3L的中位数为0.81（IQR，0.71 - 0.84）。与参照人群相比，HRQoL显著更低（<0.001）。在多变量回归分析中，吸烟与较差的HRQoL相关。较高的体重指数、深部感染和较低的HRQoL与较差的踝关节功能相关。
与未受伤的参照人群相比，pilon骨折手术治疗后患者报告的长期结局显示功能受损且HRQoL较低。由于pilon骨折可对患者生活产生重大影响，应向患者咨询预期的长期结局，以设定现实的期望。本研究强调在评估损伤后的结局时，获取通用和特定区域测量指标的重要性，以便在准确背景下评估相关损伤。
预后III级。
