Sassara Giulia Maria, Smakaj Amarildo, De Mauro Domenico, Righini Roberta, Arnone Adele, Rovere Giuseppe, El Ezzo Omar, Farsetti Pasquale, Tarantino Umberto, Liuzza Francesco
Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy.
Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
J Clin Med. 2024 May 29;13(11):3176. doi: 10.3390/jcm13113176.
: Pelvic insufficiency fractures (PIF) are typical in geriatric populations with reduced bone quality, most commonly in elderly postmenopausal women. These fractures are usually caused by low-energy forces over the bones during ordinary life and cause disabling pain. Treatment options range from conservative to operative. The aim of this study is to assess the outcomes of treatments for pelvic insufficiency fractures, determining optimal approaches between surgical intervention and conservative management. : This literature review systematically examines articles focusing on patients with PIF, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and using PubMed, Medline, and the Cochrane Library database. We took into account only full-text articles in indexed journals with available English abstracts, considering data about patient demographics, surgery, and outcomes. After screening 128 articles, this study reviewed 20 manuscripts involving 1499 patients, mostly elderly females and focusing on sacrum fractures. Common treatments included conservative methods and sacroplasty, with a few complications reported. Osteoporosis was the prevalent comorbidity, and the survival rate post-treatment was high at 92.3%. Mobility outcomes varied, with some patients experiencing significant autonomy loss. The average follow-up period was over 17 months. : This study found a cautious approach to surgery (timing of three weeks), which is reserved only for specific patterns, and it leads to increased autonomy and a lower risk of mortality. Due to the lack of pre- and postoperative scores as well as conflicting results, it is imperative to undertake further studies and research to be able to compare the alternative treatments efficiently.
骨盆不全骨折（PIF）在骨质下降的老年人群中较为典型，最常见于绝经后老年女性。这些骨折通常由日常生活中作用于骨骼的低能量外力引起，并导致致残性疼痛。治疗选择从保守治疗到手术治疗不等。本研究的目的是评估骨盆不全骨折的治疗效果，确定手术干预和保守治疗之间的最佳方法。
本系统评价遵循系统评价和Meta分析的首选报告项目指南，使用PubMed、Medline和Cochrane图书馆数据库，系统地审查了聚焦于骨盆不全骨折患者的文章。我们仅纳入了索引期刊中带有英文摘要的全文文章，考虑了有关患者人口统计学、手术和治疗效果的数据。在筛选了128篇文章后，本研究回顾了20篇涉及1499例患者的手稿，这些患者大多为老年女性，主要关注骶骨骨折。常见治疗方法包括保守治疗和骶骨成形术，报告的并发症较少。骨质疏松是常见的合并症，治疗后的生存率较高，为92.3%。活动能力结果各不相同，一些患者出现了明显的自主能力丧失。平均随访期超过17个月。
本研究发现，对于手术应采取谨慎态度（三周的手术时机），手术仅适用于特定类型，且手术可提高自主能力并降低死亡风险。由于缺乏术前和术后评分以及相互矛盾的结果，必须进行进一步的研究，以便能够有效地比较不同的治疗方法。
