Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Trauma Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
Arch Orthop Trauma Surg. 2023 May;143(5):2417-2428. doi: 10.1007/s00402-022-04438-w. Epub 2022 Apr 25.
There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently available literature regarding the indications and methods for surgical fixation of fragility fractures of the pelvic ring in elderly patients after low-energy trauma.
The Pubmed and Embase databases were searched using the key words pelvic fractures, geriatric, fragility, osteoporosis, and surgical fixation, and their synonyms. Extracted data including the indication, method of operative fixation, and post-operative outcomes (pain levels, mobility, complications and mortality) were analyzed using descriptive statistics. The studies were too heterogeneous to perform a meta-analysis.
Eleven cohort studies (3 comparative and 8 noncomparative) were included. The methodological quality was poor to moderate; the studies were heterogeneous regarding study design and reported outcomes. In all included studies operative treatment for all fracture types was preceded by a period of conservative treatment comprising physiotherapy-guided full weight-bearing. Time to surgery differed widely. For posterior ring fixation, the majority of the included studies used minimally invasive surgery with trans-iliosacral screws. Five studies described a form of additional fixation of the anterior pelvic ring but did not report the indications.
Fixation of low-energy pelvic ring fractures in elderly is commonly performed after a period of conservative treatment, with persistent pain as the most frequent indication for fixation. Fracture classification based on stability seems to be of secondary importance. Timing for surgical fixation of the pelvic ring fracture in elderly patients remains diverse. Large well-designed comparative prospective studies and randomized controlled trials are needed to provide clearly substantiated guidelines.
目前尚无普遍接受的标准来确定何时以及如何固定老年骨质疏松性骨盆环骨折。本系统评价旨在总结目前关于老年患者低能量创伤后骨盆环脆弱性骨折的手术固定适应证和方法的文献。
使用关键词“骨盆骨折”、“老年”、“脆弱性”、“骨质疏松”和“手术固定”及其同义词，在 Pubmed 和 Embase 数据库中进行检索。使用描述性统计方法分析提取的数据，包括适应证、手术固定方法和术后结果（疼痛程度、活动度、并发症和死亡率）。由于研究之间存在很大的异质性，因此无法进行荟萃分析。
共纳入 11 项队列研究（3 项比较研究和 8 项非比较研究）。方法学质量为差至中等；研究设计和报告结果存在异质性。在所有纳入的研究中，所有骨折类型的手术治疗均在前一阶段的保守治疗（包括物理治疗指导下的完全负重）后进行。手术时间差异很大。对于后环固定，大多数纳入的研究使用微创经髂骨-骶骨螺钉固定。有 5 项研究描述了一种额外固定前骨盆环的方法，但未报告适应证。
老年低能量骨盆环骨折通常在保守治疗后进行固定，持续疼痛是最常见的固定适应证。基于稳定性的骨折分类似乎次要。老年患者骨盆环骨折的手术固定时机仍存在差异。需要进行大型、精心设计的前瞻性比较研究和随机对照试验，以提供明确的循证指南。
