Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, MN.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; and.
J Orthop Trauma. 2024 Sep 1;38(9):472-476. doi: 10.1097/BOT.0000000000002863.
To compare outcomes of nonoperative and percutaneous fixation of geriatric fragility lateral compression 1 (LC1) pelvic ring fractures.
Retrospective.
Two level 1 trauma centers.
Included were patients who were 60 years or older with an isolated LC1 pelvic ring fracture managed nonoperatively or those who failed mobilization and were managed operatively with percutaneous sacral fixation. Patients with high-energy mechanisms of injury or polytrauma were excluded.
The primary outcome was pain as measured by using the visual analog scale (VAS) after treatment. Secondary outcomes included length of stay, discharge disposition, mortality, readmission rates, and complications.
In total, 231 patients were included with a mean age of 79.5 years (range 60-100). One hundred eighty-five (80.0%) patients were female. Sixty-two (26.8%) patients received percutaneous sacral fixation after failed mobilization, and 169 (73.2%) were managed nonoperatively. In the operative group, the median time to surgery was hospital day 4. Nonoperative patients were older (81.5 ± 10.0 years vs. 74.2 ± 9.4 years, P < 0.01) and had a shorter hospital length of stay (4.8 ± 6.2 days) than the operative group (10.6 ± 9.5 days, P < 0.01). Patients in the operative group had more pain (VAS 7.9 ± 3.0) than those in the nonoperative group (VAS 6.6 ± 3.0) ( P = 0.01) on admission but had similar pain control postoperatively (VAS 4.4 ± 3.0) compared with the nonoperative group (VAS 4.5 ± 3.6) on the equivalent hospital day ( P = 0.91). Thus, patients in the operative group experienced more improvement in pain (VAS 3.3 ± 2.7) compared with the nonoperative group (VAS 1.9 ± 3.9) after treatment ( P = 0.02). Ninety-day mortality ( P = 0.21) and readmission rates ( P = 0.27) were similar for both groups. Two patients in the operative cohort sustained nerve injuries, whereas 1 patient in the nonoperative group had a nonunion and underwent surgery.
Patients who undergo percutaneous surgical fixation for low-energy LC1 injuries have similar discharge disposition, mortality, complication rates, and readmission rates compared with patients treated nonoperatively. Percutaneous surgical fixation may provide significant pain relief for patients who failed conservative management.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较老年不稳定侧方挤压 1 型（LC1）骨盆环骨折非手术与经皮固定的治疗结果。
回顾性研究。
两家 1 级创伤中心。
纳入标准为年龄 60 岁或以上、接受单纯 LC1 骨盆环骨折非手术治疗或因无法活动而接受经皮骶骨固定手术治疗的患者。排除高能量损伤机制或多发伤患者。
主要结局是治疗后采用视觉模拟评分（VAS）评估的疼痛。次要结局包括住院时间、出院去向、死亡率、再入院率和并发症。
共纳入 231 例患者，平均年龄 79.5 岁（60-100 岁）。185 例（80.0%）为女性。62 例（26.8%）患者在无法活动后接受经皮骶骨固定术，169 例（73.2%）接受非手术治疗。手术组的中位手术时间为入院后第 4 天。非手术组患者年龄更大（81.5±10.0 岁比 74.2±9.4 岁，P<0.01），住院时间更短（4.8±6.2 天比 10.6±9.5 天，P<0.01）。手术组患者入院时疼痛程度更高（VAS 7.9±3.0），而非手术组患者疼痛程度较低（VAS 6.6±3.0）（P=0.01），但术后两组患者疼痛控制相似（VAS 4.4±3.0），相当于相同住院日（P=0.91）。因此，与非手术组相比，手术组患者在治疗后疼痛改善更明显（VAS 3.3±2.7 比 VAS 1.9±3.9）（P=0.02）。两组 90 天死亡率（P=0.21）和再入院率（P=0.27）相似。手术组有 2 例患者发生神经损伤，而非手术组有 1 例患者发生非愈合并接受手术。
与接受非手术治疗的患者相比，接受经皮手术固定治疗低能量 LC1 损伤的患者在出院去向、死亡率、并发症发生率和再入院率方面相似。对于经保守治疗失败的患者，经皮手术固定可能会显著缓解疼痛。
治疗性 III 级。请参见《作者须知》以获取完整的证据水平描述。
