Sanchez Thomas, Sankey Turner, Scheinberg Mila B, Schick Samuel, Singh Swapnil, Cheppalli Naga, Davis Chandler, Shah Ashish
Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA.
Orthopaedics, VA Hospital Albuquerque, Albuquerque, USA.
Cureus. 2023 Aug 15;15(8):e43536. doi: 10.7759/cureus.43536. eCollection 2023 Aug.
This research adds to the literature by providing prognostic information for physicians and patients regarding the outcomes of operative management of Maisonneuve fractures (MFs). To date, this is the only cohort study of patient-reported outcomes measurement information systems (PROMIS) scores following surgical fixation of MF. Patient outcomes were compared focusing on the mean population with an inter-analysis using basic demographic information, radiographic findings, and patient comorbidities and their respective impact on PROMIS scores.
A total of 24 patients between 2012 and 2020 met the inclusion criteria and completed PROMIS surveys at a minimum of 18 months postoperatively. Patient charts were reviewed through the electronic medical record (EMR) for demographic information and comorbidities as well as operative variables. PROMIS scores for physical function (PF), pain interference (PI), and depression were obtained via follow-up visits and phone calls. The impact of categorical variables on complications was compared using Chi-Squared tests. Variables were analyzed with a type 3 SS test to stratify independent risk factors' effect on PROMIS scores and to account for confounding variables.
PROMIS PF averaged 44.84 and was significantly affected by BMI>30 (p=.033), hypertension (HTN) (p=.026), patients with clinical anxiety or depression (p=.047), and subsequent screw removal (p=.041). PROMIS PI averaged a score of 54.57 and was significantly affected by BMI>30 (p=.0046), coronary artery disease (CAD) (p=.0123), patients with clinical anxiety or depression (p=.0206), and subsequent screw removal (p=.0039). PROMIS depression scores averaged 46.03 and were significantly affected by the presence of CAD (p=.049) and subsequent screw removal (p=.023).
Patient-reported outcomes following MF surgery demonstrated PROMIS scores within +/- 1 standard deviation of the population-based control, and thus many patients can reasonably expect to return to a level of function comparable to the general population. Nonetheless, the significant effects of patient comorbidities and surgical variables ought to be evaluated and utilized as prognostic indicators when managing patient expectations prior to operative treatment of an MF injury.
本研究通过为医生和患者提供关于马松纽夫骨折（MF）手术治疗结果的预后信息，丰富了文献资料。迄今为止，这是唯一一项关于MF手术固定后患者报告结局测量信息系统（PROMIS）评分的队列研究。通过使用基本人口统计学信息、影像学检查结果、患者合并症及其对PROMIS评分的各自影响进行相互分析，对患者结局进行了比较。
2012年至2020年间共有24例患者符合纳入标准，并在术后至少18个月完成了PROMIS调查。通过电子病历（EMR）查阅患者病历，获取人口统计学信息、合并症以及手术变量。通过随访就诊和电话获得身体功能（PF）、疼痛干扰（PI）和抑郁的PROMIS评分。使用卡方检验比较分类变量对并发症的影响。采用3型SS检验对变量进行分析，以分层独立危险因素对PROMIS评分的影响，并考虑混杂变量。
PROMIS PF平均为44.84，受BMI>30（p = 0.033）、高血压（HTN）（p = 0.026）、临床焦虑或抑郁患者（p = 0.0;47）以及随后的螺钉取出（p = 0.041）显著影响。PROMIS PI平均得分为54.57，受BMI>30（p = 0.0046）、冠状动脉疾病（CAD）（p = 0.0123）、临床焦虑或抑郁患者（p = 0.;206）以及随后的螺钉取出（p = 0.0039）显著影响。PROMIS抑郁评分平均为46.03，受CAD的存在（p = 0.049）和随后的螺钉取出（p = 0.023）显著影响。
MF手术后患者报告的结局显示PROMIS评分在基于人群的对照的±1个标准差范围内，因此许多患者可以合理期望恢复到与一般人群相当的功能水平。尽管如此，在对MF损伤进行手术治疗之前管理患者期望时，患者合并症和手术变量的显著影响应作为预后指标进行评估和利用。
