Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131, Mainz, Germany.
Department of Orthopedics and Traumatology, Westpfalz Clinics Kaiserslautern, Helmut-Hartert-Strasse 1, 67655, Kaiserslautern, Germany.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2881-2896. doi: 10.1007/s00068-021-01799-6. Epub 2021 Oct 11.
Fragility fractures of the pelvis (FFP) are a clinical entity with an increasing frequency. Indications for and type of surgical treatment are still a matter of debate.
This retrospective study presents and critically analyses the results of operative treatment of 140 patients with FFP.
Level-I trauma center.
Demographic data, comorbidities, FFP-classification, type of surgical stabilization (percutaneous (P-group) versus open procedure (O-group)), length of hospital stay (LoS), general in-hospital complications, surgery-related complications, living environment before admission, mobility and destination at discharge were retracted from the medical and radiographic records. Patients were asked participating in a survey by telephone call about their quality of life. SF-8 Physical Component Score (PCS) and SF-8 Mental Component Score (MCS) were calculated as well as the Parker Mobility Score (PMS) and the Numeric Rating Scale (NRS).
Mean age was 77.4 years and 89.3% of patients were female. 92.1% presented with one comorbidity, 49.3% with two or more comorbidities. Median length of hospital stay was 18 days, postoperative length of hospital stay was 12 days. 99 patients (70.7%) received a percutaneous operative procedure, 41 (29.3%) an open. Patients of the O-group had a significantly longer LoS than patients of the P-group (p = 0.009). There was no in-hospital mortality. There were significantly more surgery-related complications in the O-group (43.9%) than in the P-group (19.2%) (p = 0.006). Patients of the O-group needed more often surgical revisions (29.3%) than patients of the P-group (13.1%) (p = 0.02). Whereas 85.4% of all patients lived at home before admission, only 28.6% returned home at discharge (p < 0.001). The loss of mobility at discharge was not influenced by the FFP-classes (p = 0.47) or type of treatment (p = 0.13). One-year mortality was 9.7%. Mortality was not influenced by the FFP-classes (p = 0.428) or type of treatment (p = 0.831). Median follow-up was 40 months. SF-8 PCS and SF-8 MCS were moderate (32.43 resp. 54.42). PMS was 5 and NRS 4. Follow-up scores were not influenced by FFP-classes or type of treatment.
Patients with FFP, who were treated operatively, suffered from a high rate of non-lethal general, in-hospital complications. Open surgical procedures induced more surgery-related complications and surgical revisions. Mental and physical follow-up scores are low to moderate. Condition at follow-up is not influenced by FFP-classes or type of treatment. Indications for operative treatment of FFP must be critically examined. Surgical fixation should obtain adequate stability, yet be as less invasive as possible. The advantages and limitations of different surgical techniques have to be critically evaluated in prospective studies.
骨盆脆性骨折（FFP）是一种发病率不断增加的临床实体。手术治疗的适应证和类型仍存在争议。
本回顾性研究介绍并批判性分析了 140 例 FFP 患者手术治疗的结果。
一级创伤中心。
从病历和影像学记录中提取患者的人口统计学数据、合并症、FFP 分类、手术稳定类型（经皮（P 组）与开放手术（O 组））、住院时间（LoS）、一般院内并发症、与手术相关的并发症、入院前的居住环境、出院时的活动能力和去向。通过电话询问患者参与调查，了解其生活质量。计算 SF-8 身体成分评分（PCS）和 SF-8 心理成分评分（MCS）以及帕克活动能力评分（PMS）和数字评分量表（NRS）。
平均年龄为 77.4 岁，89.3%的患者为女性。92.1%的患者有 1 种合并症，49.3%的患者有 2 种或 2 种以上合并症。中位住院时间为 18 天，术后住院时间为 12 天。99 例（70.7%）患者接受经皮手术治疗，41 例（29.3%）患者接受开放手术治疗。O 组患者的 LOS 明显长于 P 组（p=0.009）。院内无死亡病例。O 组的手术相关并发症明显多于 P 组（43.9%比 19.2%）（p=0.006）。O 组患者需要手术修正的频率明显高于 P 组（29.3%比 13.1%）（p=0.02）。入院前，所有患者中有 85.4%居住在自己家中，但只有 28.6%在出院时返回自己家中（p<0.001）。出院时的活动能力丧失与 FFP 分类（p=0.47）或治疗类型（p=0.13）无关。一年死亡率为 9.7%。死亡率不受 FFP 分类（p=0.428）或治疗类型（p=0.831）的影响。中位随访时间为 40 个月。SF-8 PCS 和 SF-8 MCS 为中等水平（分别为 32.43 和 54.42）。PMS 为 5，NRS 为 4。随访评分不受 FFP 分类或治疗类型的影响。
接受手术治疗的 FFP 患者普遍存在较高的非致命性一般院内并发症发生率。开放性手术会导致更多的手术相关并发症和手术修正。精神和身体的随访评分较低。随访时的情况不受 FFP 分类或治疗类型的影响。FFP 手术治疗的适应证必须进行严格审查。手术固定应获得足够的稳定性，但又要尽可能微创。不同手术技术的优缺点必须在前瞻性研究中进行批判性评估。
