Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
UNC Orthopaedics, Chapel Hill, NC.
J Orthop Trauma. 2024 Nov 1;38(11):592-595. doi: 10.1097/BOT.0000000000002902.
To compare outcomes and complications between nonoperative and operative management of femur and tibia fractures in patients with paraplegia or quadriplegia from chronic spinal cord injury (SCI).
Retrospective cohort study.
Three Level-1 Trauma centers.
All adult patients with paraplegia or quadriplegia due to a chronic SCI with operative or nonoperative treatment of a femoral or tibial shaft fracture from January 1, 2009 through December 31, 2019 were included.
Outcomes collected included range of motion, pain, return to baseline activity, extent of malunion, and treatment complications (infection, pressure ulcers, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death). Comparison between operative and nonoperative treatment were made for each outcome.
Fifty-nine patients with acute lower extremity fracture in the setting of chronic SCI fulfilled inclusion criteria with a median age of 46 years in the operative group and 47 years in the nonoperative group. Twelve patients (70.6%) in the nonoperative group were male with 32 (76.2%) male patients in the operative group. Forty-six patients (78%) presented as low energy trauma. Differences were seen between operative and nonoperative management for pressure ulcers (19% vs. 52.9%, P = 0.009) and mean Visual Analog Scale pain score at first follow-up (1.19 vs. 3.3, P = 0.03). No difference was seen for rates of infection, nonunion, deep vein thrombosis/pulmonary emobolus, stroke, amputation, death, return to baseline activity, and range of motion.
Tibial and femoral shaft fractures commonly resulted from low energy mechanisms in patients with chronic SCI. Operative treatment seemed to decrease morbidity in these patients via lowered rates of pressure ulcers and decreased pain compared with nonoperative management.
Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.
比较慢性脊髓损伤（SCI）截瘫或四肢瘫患者股骨和胫骨骨折的非手术和手术治疗的结果和并发症。
回顾性队列研究。
三个 1 级创伤中心。
所有因慢性 SCI 导致截瘫或四肢瘫的成年患者，在 2009 年 1 月 1 日至 2019 年 12 月 31 日期间接受了股骨或胫骨骨干骨折的手术或非手术治疗，均纳入本研究。
收集的结果包括活动范围、疼痛、恢复到基线活动水平、畸形愈合程度以及治疗并发症（感染、压疮、骨不连、深静脉血栓/肺栓塞、中风、截肢、死亡）。对每种结果分别比较手术和非手术治疗。
59 例慢性 SCI 合并急性下肢骨折患者符合纳入标准，手术组的中位年龄为 46 岁，非手术组的中位年龄为 47 岁。非手术组 12 例（70.6%）为男性，手术组 32 例（76.2%）为男性。46 例（78%）为低能量创伤。手术和非手术治疗在压疮（19% vs. 52.9%，P=0.009）和首次随访时的平均视觉模拟量表疼痛评分（1.19 vs. 3.3，P=0.03）方面存在差异。两组在感染、骨不连、深静脉血栓/肺栓塞、中风、截肢、死亡、恢复到基线活动水平和活动范围方面无差异。
慢性 SCI 患者的胫骨和股骨骨干骨折通常由低能量机制引起。与非手术治疗相比，手术治疗似乎通过降低压疮发生率和减轻疼痛来降低这些患者的发病率。
治疗，III 级。有关证据水平的完整描述，请参见作者说明。
