Yamamoto Norio, Someko Hidehiro, Tsuge Takahiro, Nakashima Yuki, Nakao Shuri
Department of Orthopedic Surgery, Minato Medical Coop-Kyoritsu General Hospital, Nagoya, Aichi, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
Injury. 2024 Oct;55(10):111727. doi: 10.1016/j.injury.2024.111727. Epub 2024 Jul 16.
Fragility fractures of the pelvis (FFP) are a growing problem in aging populations. Fracture progression (FP) occasionally occurs during FFP treatment; however, its prevalence remains unclear. This systematic review and meta-analysis aimed to assess the prevalence of FP among patients with FFP.
We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All cohort studies that reported the prevalence of FP in patients with FFP were included. FP was defined as the appearance of additional pelvic fractures after the initial FFP. We searched the CENTRAL, MEDLINE, and EMBASE databases until April 2024. The pooled prevalence was generated using a random-effects model and presented as a 95 % confidence interval (CI) and prediction interval (PI). We assessed the risk of bias in each study using the Joanna Briggs Institute's Prevalence Critical Appraisal Tool.
This review included eight studies (925 patients). The pooled prevalence of FP in patients with FFP was 11 % (95 % CI, 5-19 %; 95 % PI, 0-44 %). Subgroup analysis showed that the pooled prevalence of FP in patients with FFP (conservative treatment vs. surgery for initial FFP) was 16 % (95 % CI, 9-24 %) and 2 % (95 % CI, 0-11 %), respectively (test for subgroup difference, P = 0.03). Additional analysis showed that in patients with FP, the pooled prevalence of the fractured site (ipsilateral site, contralateral site, and both sites) was 66 %, 12 %, and 19 %, respectively. The pooled prevalence of fractured bone (pubis, ischium, ilium, and sacrum) was 25 %, 0 %, 15 %, and 68 %, respectively. The risk of bias in the patient sampling method and sufficient data analysis in all included studies was high.
This review suggests that the prevalence of FP in patients with FFP is relatively high. Clinicians should recognize FP as a possible diagnosis in patients experiencing additional pain after FFP. However, further prospective studies with adequate patient sampling are required to confirm the true prevalence.
骨盆脆性骨折（FFP）在老年人群中是一个日益严重的问题。骨折进展（FP）在FFP治疗期间偶尔会发生；然而，其患病率仍不清楚。本系统评价和荟萃分析旨在评估FFP患者中FP的患病率。
我们按照系统评价和荟萃分析的首选报告项目进行了系统评价和荟萃分析。纳入所有报告FFP患者中FP患病率的队列研究。FP定义为初始FFP后出现额外的骨盆骨折。我们检索了CENTRAL、MEDLINE和EMBASE数据库直至2024年4月。使用随机效应模型生成合并患病率，并以95%置信区间（CI）和预测区间（PI）表示。我们使用乔安娜·布里格斯研究所的患病率批判性评价工具评估每项研究的偏倚风险。
本评价纳入了八项研究（925例患者）。FFP患者中FP的合并患病率为11%（95%CI，5-19%；95%PI，0-44%）。亚组分析显示，FFP患者（初始FFP采用保守治疗与手术治疗）中FP的合并患病率分别为16%（95%CI，9-24%）和2%（95%CI，0-11%）（亚组差异检验，P=0.03）。进一步分析显示，在发生FP的患者中，骨折部位（同侧部位、对侧部位和双侧部位）的合并患病率分别为66%、12%和19%。骨折骨骼（耻骨、坐骨、髂骨和骶骨）的合并患病率分别为25%、0%、15%和68%。所有纳入研究中患者抽样方法和充分数据分析的偏倚风险较高。
本评价表明，FFP患者中FP的患病率相对较高。临床医生应将FP视为FFP后出现额外疼痛患者的一种可能诊断。然而，需要进一步进行有足够患者抽样的前瞻性研究来确认真实患病率。
