手术与非手术治疗应激性轻度移位外侧压缩型 1 型骨盆环损伤的早期结果。

Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries.

机构信息

Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.

出版信息

J Orthop Trauma. 2023 Oct 1;37(10):506-512. doi: 10.1097/BOT.0000000000002642.

DOI:10.1097/BOT.0000000000002642

PMID:37296089

Abstract

OBJECTIVES

To compare the early outcomes of patients with stress-positive minimally displaced lateral compression type 1 (LC1b) pelvic ring injuries managed with or without operative fixation.

DESIGN

Retrospective comparison study.

SETTING

Level 1 trauma center.

PATIENTS/PARTICIPANTS: Forty-three patients with LC1b injuries.

INTERVENTION

Operative versus nonoperative.

MAIN OUTCOME MEASUREMENTS

Discharge to subacute rehabilitation (SAR); 2- and 6-week pain visual analog score, opioid use, assistive device use, percentage of normal single assessment numerical evaluation, SAR status; fracture displacement; and complications.

RESULTS

The operative group did not differ in age, gender, body mass index, high-energy mechanism, dynamic displacement stress radiographs, complete sacral fractures, Denis sacral fracture classification, Nakatani rami fracture classification, follow-up length, or American Society of Anesthesiologists classification. The operative group was less likely to be using an assistive device at 6 weeks [observed difference (OD) -53.9%, 95% confidence interval (CI) -74.3% to -20.6%, OD/CI 1.00, P = 0.0005], less likely to remain in an SAR at 2 weeks (OD -27.5%, CI, -50.0% to -2.7%, OD/CI 0.58, P = 0.02), and had less fracture displacement at follow-up radiographs (OD -5.0 mm, CI, -9.2 to -1.0 mm, OD/CI 0.61, P = 0.02). There were no other differences in outcomes between treatment groups. Complications occurred in 29.6% (n = 8/27) of the operative group compared with 25.0% (n = 4/16) of the nonoperative group resulting in 7 and 1 additional procedures, respectively.

CONCLUSIONS

Operative treatment was associated with early benefits over nonoperative management, including shorter time using assistive devices, less SAR use, and less fracture displacement at follow-up.

LEVEL OF EVIDENCE

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

摘要

目的

比较手术固定与非手术固定治疗应力阳性轻度移位外侧挤压型 1 型（LC1b）骨盆环损伤患者的早期结果。

设计

回顾性比较研究。

地点

1 级创伤中心。

患者/参与者：43 例 LC1b 损伤患者。

干预措施

手术与非手术。

主要观察指标

出院至亚急性康复（SAR）；2 周和 6 周时疼痛视觉模拟评分、阿片类药物使用、辅助设备使用、正常单评估数字评估的百分比、SAR 状态；骨折移位；并发症。

结果

手术组在年龄、性别、体重指数、高能机制、动态移位应力射线照相、完全骶骨骨折、Denis 骶骨骨折分类、Nakatani 棘突骨折分类、随访时间或美国麻醉医师协会分类方面无差异。手术组在 6 周时使用辅助设备的可能性较小[观察差异（OD）-53.9%，95%置信区间（CI）-74.3%至-20.6%，OD/CI 1.00，P=0.0005]，2 周时留在 SAR 的可能性较小[OD-27.5%，CI，-50.0%至-2.7%，OD/CI 0.58，P=0.02]，随访时骨折移位较小[OD-5.0mm，CI，-9.2 至-1.0mm，OD/CI 0.61，P=0.02]。两组之间的其他结果没有差异。手术组并发症发生率为 29.6%（n=8/27），非手术组为 25.0%（n=4/16），分别导致 7 例和 1 例额外手术。