骨盆脆性骨折的长期临床结局如何？——一项基于 CT 的横断面研究。
What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study.
机构信息
University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands.
Radboud University, Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands.
出版信息
Injury. 2022 Feb;53(2):506-513. doi: 10.1016/j.injury.2021.09.056. Epub 2021 Oct 1.
BACKGROUND
Recently, Rommens and Hoffman introduced a CT-based classification system for fragility fractures of the pelvis (FFP). Although fracture characteristics have been described, the relationship with clinical outcome is lacking. The purpose of this study was to get insight into the type of treatment and subsequent clinical outcome after all types of FFP.
METHODS
A cross-sectional cohort study was performed including all elderly patients (≥ 65 years) with a CT-diagnosed FFP, between 2007-2019 in two level 1 trauma centers. Data regarding treatment, mortality and clinical outcome was gathered from the electronic patient files. Patients were asked to complete patient-reported outcome measures (PROMs) regarding physical functioning (SMFA) and quality of life (EQ-5D). Additionally, a standardized multidisciplinary treatment algorithm was constructed.
RESULTS
A total of 187 patients were diagnosed with an FFP of whom 117 patients were available for follow-up analysis and 58 patients responded. FFP type I was most common (60%), followed by type II (27%), type III (8%) and type IV (5%). Almost all injuries were treated non-operatively (98%). Mobility at six weeks ranged from 50% (type III) to 80% type II). Mortality at 1 year was respectively 16% (type I and II), 47% (type III) and 13% (type IV). Physical functioning (SMFA function index) ranged from 62 (type III and IV) to 69 (type II) and was significantly decreased (P=<0.001) compared to the age-matched general population. Quality of life was also significantly decreased, ranging from 0.26 (type III) to 0.69 (type IV).
CONCLUSIONS
FFP type I and II are most common. Treatment is mainly non-operative, resulting in good mobility after six weeks, especially for patients with FFP type I and II. Mortality rates at one year were substantial in all patients. Physical functioning and quality of life was about 20-30% decreased compared to the general population.
背景
最近，Rommens 和 Hoffman 引入了一种基于 CT 的骨盆脆性骨折（FFP）分类系统。尽管已经描述了骨折特征，但缺乏与临床结果的关系。本研究的目的是深入了解所有类型 FFP 后的治疗类型和随后的临床结果。
方法
这是一项横断面队列研究，纳入了 2007 年至 2019 年间在 2 个 1 级创伤中心接受 CT 诊断的所有老年患者（≥65 岁）。从电子病历中收集有关治疗、死亡率和临床结果的数据。要求患者完成身体功能（SMFA）和生活质量（EQ-5D）的患者报告结局测量（PROM）。此外，还构建了一个标准化的多学科治疗算法。
结果
共诊断出 187 例 FFP，其中 117 例可进行随访分析，58 例患者做出了回应。最常见的是 FFP 型 I（60%），其次是 FFP 型 II（27%）、FFP 型 III（8%）和 FFP 型 IV（5%）。几乎所有的损伤都是非手术治疗（98%）。6 周时的活动能力从 50%（FFP 型 III）到 80%（FFP 型 II）不等。1 年内的死亡率分别为 16%（FFP 型 I 和 II）、47%（FFP 型 III）和 13%（FFP 型 IV）。身体功能（SMFA 功能指数）从 62（FFP 型 III 和 IV）到 69（FFP 型 II）不等，与年龄匹配的一般人群相比明显下降（P<0.001）。生活质量也明显下降，范围从 0.26（FFP 型 III）到 0.69（FFP 型 IV）。
结论
FFP 型 I 和 II 最常见。治疗主要是非手术治疗，特别是对于 FFP 型 I 和 II 的患者，6 周后活动能力良好。所有患者的 1 年死亡率都很高。与一般人群相比，身体功能和生活质量下降了 20-30%。
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