Mishra Sanket, Satapathy Deepankar, Zion Nego, Lodh Udeepto
Department of Orthopaedic Surgery, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND.
Cureus. 2022 Jun 22;14(6):e26195. doi: 10.7759/cureus.26195. eCollection 2022 Jun.
Pelvic bone fracture is often observed in high-speed road traffic accidents, and forms a medical emergency as it is often complicated with associated internal exsanguination, shock, and mortality. Managing such cases cost-effectively in a developing country with limited assets, without compromising on patient outcomes still remains an obstacle.
To compare and contrast the clinical aftermath of urgent non-surgical and surgical treatment of closed pelvic ring fracture patients and to analyze the types and severity of complications and final functional outcome.
Twenty-five patients with pelvic fractures received at the casualty of IMS and SUM Hospital, Bhubaneswar, between January 2017 and January 2018 were included in the study. Marvin Tile classification was used to classify the fractures. Analysis and assessment of patients were done preoperatively and at six-month follow-up after management, with radiology and functional score using D'Aubinge-Postel Scale. The mode of injury, various management protocols for each type of fracture pattern, and associated complications were also noted. And finally, an outcome comparison was drawn between surgical and non-surgical options for various fractures. A Chi-square test was used to compare the outcomes.
The functional outcome as per the D'Aubigne-Postel Scale, on average six months, was excellent in nine patients (36%), good in seven (28%), fair in four (16%), and poor in four (16%). The outcome comparison was insignificant statistically in both radiological assessment (p 0.614) and functional scores (p 0.26) between the conservative and surgical outcomes. The average duration of hospital stay, duration to ambulation, duration to full recovery, and complications were significantly more in patients managed conservatively. While the cost of treatment was more in the surgical group. One death was observed in the study group due to septicemia which might have been directly related to the severity of pelvic injury and choice of treatment.
Tile's Type B and C fractures, managed surgically allow faster mobilization of the patient and a shorter recovery period while the cost of treatment is significantly more. Tiles type A is best managed conservatively.
骨盆骨折在高速道路交通事故中较为常见，由于常伴有内出血、休克和死亡等并发症，因而构成医疗急症。在资源有限的发展中国家，在不影响患者治疗效果的前提下，经济高效地处理此类病例仍是一个难题。
比较和对比闭合性骨盆环骨折患者紧急非手术治疗和手术治疗的临床后果，并分析并发症的类型和严重程度以及最终的功能结局。
纳入2017年1月至2018年1月期间在布巴内斯瓦尔的IMS和SUM医院急诊室收治的25例骨盆骨折患者。采用马文·泰尔（Marvin Tile）分类法对骨折进行分类。在术前以及治疗后6个月随访时，利用达宾-波斯特尔（D'Aubinge-Postel）量表对患者进行放射学和功能评分分析及评估。同时记录损伤方式、每种骨折类型的各种治疗方案以及相关并发症。最后，对不同骨折的手术和非手术治疗方案的结果进行比较。采用卡方检验比较结果。
根据达宾-波斯特尔量表，平均6个月时，9例患者（36%）功能结局为优，7例（28%）为良，4例（16%）为中，4例（16%）为差。保守治疗和手术治疗的放射学评估（p = 0.614）和功能评分（p = 0.26）结果比较，差异均无统计学意义。保守治疗患者的平均住院时间、下床活动时间、完全康复时间及并发症明显更多。而手术组的治疗费用更高。研究组有1例患者因败血症死亡，这可能与骨盆损伤的严重程度和治疗选择直接相关。
采用手术治疗的泰尔（Tile）B型和C型骨折患者能够更快活动，恢复期更短，但治疗费用明显更高。泰尔A型骨折最好采用保守治疗。
