Elam Rachel E, Ray Cara E, Miskevics Scott, Weaver Frances M, Gonzalez Beverly, Obremskey William, Carbone Laura D
Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
Division of Rheumatology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Spinal Cord. 2023 Apr;61(4):260-268. doi: 10.1038/s41393-023-00879-1. Epub 2023 Feb 16.
This is a retrospective case-control study.
To identify predictors of lower extremity (LE) long bone fracture-related amputation in persons with traumatic spinal cord injury (tSCI).
US Veterans Health Administration facilities (2005-2015).
Fracture-amputation sets in Veterans with tSCI were considered for inclusion if medical coding indicated a LE amputation within 365 days following an incident LE fracture. The authors adjudicated each fracture-amputation set by electronic health record review. Controls with incident LE fracture and no subsequent amputation were matched 1:1 with fracture-amputation sets on site and date of fracture (±30 days). Multivariable conditional logistic regression determined odds ratios (OR) and 95% confidence intervals (CI) for potential predictors (motor-complete injury; diabetes mellitus (DM); peripheral vascular disease (PVD); smoking; primary (within 30 days) nonsurgical fracture management; pressure injury and/or infection), controlling for age and race.
Forty fracture-amputation sets from 37 Veterans with LE amputations and 40 unique controls were identified. DM (OR = 26; 95% CI, 1.7-382), PVD (OR = 30; 95% CI, 2.5-371), and primary nonsurgical management (OR = 40; 95% CI, 1.5-1,116) were independent predictors of LE fracture-related amputation.
Early and aggressive strategies to prevent DM and PVD in tSCI are needed, as these comorbidities are associated with increased odds of LE fracture-related amputation. Nonsurgical fracture management increased the odds of LE amputation by at least 50%. Further large, prospective studies of fracture management in tSCI are needed to confirm our findings. Physicians and patients should consider the potential increased risk of amputation associated with non-operative management of LE fractures in shared decision making.
这是一项回顾性病例对照研究。
确定创伤性脊髓损伤（tSCI）患者下肢（LE）长骨骨折相关截肢的预测因素。
美国退伍军人健康管理局设施（2005 - 2015年）。
如果医疗编码显示在LE骨折事件发生后的365天内进行了LE截肢，则将tSCI退伍军人中的骨折 - 截肢病例纳入研究。作者通过电子健康记录审查对每个骨折 - 截肢病例进行判定。将发生LE骨折且随后未截肢的对照与骨折 - 截肢病例按骨折部位和日期（±30天）进行1:1匹配。多变量条件逻辑回归确定潜在预测因素（运动完全性损伤；糖尿病（DM）；外周血管疾病（PVD）；吸烟；初次（30天内）非手术骨折处理；压疮和/或感染）的比值比（OR）和95%置信区间（CI），并对年龄和种族进行控制。
确定了来自37例进行LE截肢的退伍军人的40个骨折 - 截肢病例以及40个独特的对照。DM（OR = 26；95% CI，1.7 - 382）、PVD（OR = 30；95% CI，2.5 - 371）和初次非手术处理（OR = 40；95% CI，1.5 - 1116）是LE骨折相关截肢的独立预测因素。
需要采取早期且积极的策略来预防tSCI患者的DM和PVD，因为这些合并症与LE骨折相关截肢的几率增加有关。非手术骨折处理使LE截肢的几率增加了至少50%。需要进一步开展关于tSCI骨折处理的大型前瞻性研究以证实我们的发现。在共同决策时，医生和患者应考虑LE骨折非手术治疗可能增加的截肢风险。
