前后联合固定与单纯后路固定治疗应力阳性轻度移位外侧挤压型 1 型（LC1）骨盆环损伤。

Combined Anterior-Posterior versus Posterior-Only Fixation of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries.

机构信息

Department of Orthopedics, Denver Health Medical Center, Denver, CO.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO.

出版信息

J Orthop Trauma. 2023 Apr 1;37(4):189-194. doi: 10.1097/BOT.0000000000002519.

DOI:10.1097/BOT.0000000000002519

PMID:36395075

Abstract

OBJECTIVES

To compare hospital outcomes and late displacement between stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries treated with combined anterior-posterior versus posterior-only fixation.

DESIGN

Retrospective comparative cohort.

SETTING

Urban level-one trauma center.

PATIENTS/PARTICIPANTS: LC1 injuries managed operatively.

INTERVENTION

Anterior-posterior versus posterior-only fixation.

MAIN OUTCOME MEASUREMENTS

Physical therapy (PT) clearance, discharge location, hospital length of stay (LOS), inpatient morphine equivalent doses (MED), and fracture displacement at follow-up.

RESULTS

Groups were similar in demographic and injury characteristics (age, high energy mechanism, ASA score, stress displacement, and rami/sacral fracture classifications). Anterior-posterior fixation resulted in longer operative times (median difference (MD): 27.0 minutes, 95% confidence interval (CI): 17.0 to 40.0, P < 0.0001) and had a trend of increased estimated blood loss (MD: 10 mL, CI: 0 to 30, P = 0.07). Patients with anterior-posterior fixation required less inpatient MEDs (MD: -180.0, CI: -341.2 to -15.0, P = 0.02), were more likely to clear PT by discharge (100% vs. 70%, proportional difference (PD): 30%, CI: 2.0%-57.2%, P = 0.02), were less likely to discharge to rehabilitation facilities (0% vs. 30%, PD: 30%, CI: 2.0%-57.2%, P = 0.02), and had a trend of less days to clear PT after surgery (MD: -1, CI: -2 to 0, P = 0.09) and decreased LOS (MD: -1, CI: -4 to 1, P = 0.17). Late fracture displacement did not differ between groups.

CONCLUSION

Anterior-posterior fixation of LC1 injuries was associated with an improved early hospital course-specifically, reduced inpatient opioid use and an increased number of patients who could clear PT and discharge home.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较前后联合与单纯后路固定治疗应力阳性轻度移位外侧压缩型 1 型（LC1）骨盆环损伤的医院转归和迟发性移位。

设计

回顾性比较队列。

地点

城市一级创伤中心。

患者/参与者：手术治疗的 LC1 损伤。

干预措施

前后联合与单纯后路固定。

主要观察指标

物理治疗（PT）清除、出院地点、住院时间（LOS）、住院内吗啡等效剂量（MED）和随访时骨折移位。

结果

两组在人口统计学和损伤特征（年龄、高能机制、ASA 评分、应力移位和支/骶骨骨折分类）方面相似。前后联合固定导致手术时间延长（中位数差值（MD）：27.0 分钟，95%置信区间（CI）：17.0 至 40.0，P < 0.0001），且估计失血量有增加趋势（MD：10 mL，CI：0 至 30，P = 0.07）。前后联合固定的患者需要更少的住院内 MED（MD：-180.0，CI：-341.2 至-15.0，P = 0.02），更有可能在出院时通过 PT 清除（100%比 70%，比例差异（PD）：30%，CI：2.0%至 57.2%，P = 0.02），不太可能出院到康复设施（0%比 30%，PD：30%，CI：2.0%至 57.2%，P = 0.02），并且术后 PT 清除的天数有减少趋势（MD：-1，CI：-2 至 0，P = 0.09）和 LOS 减少（MD：-1，CI：-4 至 1，P = 0.17）。两组的迟发性骨折移位无差异。