Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China.
Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
JAMA Netw Open. 2024 Mar 4;7(3):e241556. doi: 10.1001/jamanetworkopen.2024.1556.
The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial.
To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023.
The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4).
A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90).
The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.
创伤性脑损伤（TBI）后肢体骨折固定的最佳时机仍存在争议。
研究 TBI 后 24 小时内接受肢体固定的患者与 24 小时或更长时间后接受该手术的患者相比，其预后是否更差。
设计、地点和参与者：这项队列研究使用了来自欧洲颅脑外伤有效性研究协作组（CENTER-TBI）研究的数据。符合条件的患者为年龄在 16 岁及以上、TBI 并接受内部肢体固定的患者。为了比较预后，将在 24 小时内接受该手术的患者与在 24 小时或更长时间内接受该手术的患者进行倾向评分匹配。患者于 2014 年 12 月 9 日至 2017 年 12 月 17 日接受治疗。数据分析于 2022 年 8 月 1 日至 2023 年 12 月 25 日进行。
主要结局为 6 个月时不良功能状态（Glasgow 结局量表扩展版[GOSE]评分≤4）。
共有 253 名患者纳入本研究。中位年龄为 41（IQR，27-57）岁，184 名患者（72.7%）为男性。中位损伤严重程度评分（ISS）为 41（IQR，27-49）。约一半的患者（122 例[48.2%]）患有轻度 TBI，120 例（47.4%）患有中重度 TBI。74 例（29.2%）患者在 24 小时内接受了内部肢体固定，179 例（70.8%）患者在 24 小时或更长时间后接受了该手术。6 个月时，86 名患者（34.0%）存在不良功能结局。在进行倾向评分匹配后，严重程度任何程度的 TBI 患者在 6 个月时的不良功能结局均无统计学差异（OR，1.12[95%CI，0.51-1.99]；P=0.77）。在轻度 TBI 患者（OR，0.71[95%CI，0.22-2.29]；P=0.56）和中重度 TBI 患者（OR，1.08[95%CI，0.32-3.70]；P=0.89）中也观察到了类似的结果。
TBI 后 24 小时内进行的肢体骨折固定的结果似乎并不比 24 小时或更长时间后进行的手术差。这一发现表明，对于轻度头部损伤的患者，可以考虑在 TBI 后尽早进行固定。
