应力阳性、轻度移位的外侧挤压型 1（LC1）骨盆环损伤的手术治疗：实施科室应激方案前后结局的分析。

Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol.

机构信息

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

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

出版信息

J Orthop Trauma. 2023 Jun 1;37(6):263-269. doi: 10.1097/BOT.0000000000002567.

DOI:10.1097/BOT.0000000000002567

PMID:36631393

Abstract

OBJECTIVES

To compare the hospital course of patients with minimally displaced (<1 cm) lateral compression type 1 injuries treated before and after implementation of lateral stress radiographs (LSRs) to determine management.

DESIGN

Retrospective comparative cohort.

SETTING

Urban level 1 trauma center.

PATIENTS/PARTICIPANTS: Isolated lateral compression type 1 injuries managed before (n = 33) and after implementation of LSRs (n = 40) to determine management.

INTERVENTION

Patients in a prestress cohort managed nonoperatively versus patients in an LSR cohort managed operatively if stress positive (≥1 cm displacement on LSRs).

MAIN OUTCOME MEASUREMENTS

Physical therapy clearance before discharge, discharge location, hospital length of stay, and inpatient opioid morphine milligram equivalents were measured.

RESULTS

The prestress and LSR protocol groups were similar in demographic/injury characteristics (age, sex, mechanism, American Society of Anesthesiologists score, Nakatani classification, bilateral/unilateral injury, Denis zone, sacral fracture completeness, and sacral comminution). Forty-five percent of LSR protocol patients were stress-positive (n = 18) and managed operatively. The LSR protocol group was more likely to clear physical therapy by discharge (97.5% vs. 75.8%, PD: 21.7%, 95% CI: 5.1%-36.8%, P = 0.009), less likely to discharge to a rehabilitation facility (2.5% vs. 18.2%, PD: -15.7%, CI: -30.0% to -0.5%, P = 0.04), and had no difference in length of stay (MD: 0.0, CI:-1.0 to 1.0, P = 0.57) or inpatient opioid morphine milligram equivalents (MD: 9.0, CI: -60.0 to 101.0, P = 0.71).

CONCLUSION

Implementation of an LSR protocol to determine management of minimally displaced stress-positive lateral compression type 1 injuries was associated with increased rates of operative management, physical therapy clearance by discharge, and a reduction in the number of patients discharging to rehabilitation facilities.

LEVEL OF EVIDENCE

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

摘要

目的

比较实施侧向应力量表（LSR）前后治疗轻度移位（<1 厘米）外侧压缩 1 型损伤患者的住院过程，以确定治疗方法。

设计

回顾性比较队列。

地点

城市 1 级创伤中心。

患者/参与者：单独的外侧压缩 1 型损伤，在实施 LSR 之前（n = 33）和之后（n = 40）进行管理，以确定治疗方法。

干预

如果压力呈阳性（LSR 上的位移≥1 厘米），则将术前队列中的患者非手术治疗与 LSR 队列中的患者手术治疗进行比较。

主要观察指标

出院前物理治疗清除、出院地点、住院时间和住院内阿片类药物吗啡毫克当量。

结果

术前和 LSR 方案组在人口统计学/损伤特征（年龄、性别、机制、美国麻醉医师协会评分、中谷分类、单侧/双侧损伤、丹尼斯区、骶骨骨折完整性、骶骨粉碎）方面相似。LSR 方案组 45%（n = 18）的患者压力呈阳性，接受手术治疗。LSR 方案组更有可能在出院时通过物理治疗（97.5%比 75.8%，PD：21.7%，95%CI：5.1%-36.8%，P = 0.009），不太可能出院康复（2.5%比 18.2%，PD：-15.7%，CI：-30.0%至-0.5%，P = 0.04），且住院时间（MD：0.0，CI：-1.0 至 1.0，P = 0.57）或住院内阿片类药物吗啡毫克当量（MD：9.0，CI：-60.0 至 101.0，P = 0.71）无差异。