18至50岁成年人股骨远端骨折固定术的临床及患者报告结局
Clinical and patient-reported outcomes of distal femur fracture fixation in adults aged 18-50 years.
作者信息
Tung Wei Shao, Wagner Robert K, Borgida Jacob S, Brinkman Niels, Muhammad Maaz, Musick Adam N, Gregg Austin T, Policicchio Thomas J, Stenquist Derek S, Ly Thuan V
机构信息
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, United States.
Harvard Medical School Orthopaedic Trauma Initiative, Boston, United States.
出版信息
Eur J Orthop Surg Traumatol. 2025 Jun 27;35(1):284. doi: 10.1007/s00590-025-04392-4.
PURPOSE
To describe nonunion and fracture-related infection (FRI) rates and patient-reported outcomes following operative treatment for distal femur fractures in young patients.
METHODS
We retrospectively identified all patients (aged 18-50) who were operatively treated for a distal femur fracture between 2006 and 2023 with ≥ 3-month clinical follow-up at two Level 1 Trauma Centers. Outcomes included reoperation for nonunion and FRI; and PROMIS physical function (PF), depression, and anxiety (reference population mean: 50). Multiple linear regression was performed to identify factors associated with PROMIS-PF.
RESULTS
Eighty-six patients met inclusion criteria. The median age was 34 years, 71% were male, 42% had an open fracture, and for 38 patients PROMIS scores were collected at an average of 9.8 years after treatment. Eleven patients (13%) required reoperation for nonunion and 3 (3.5%) for FRI. Median PROMIS-PF was 47.0 (IQR: 41.2-52.4), depression 45.8 (IQR: 38.9-53.6), and anxiety 46.7 (IQR: 39.5-60.5). PROMIS-PF was lower than the reference population score (p < 0.05). Increased age (1-year; ß: - 0.39; 95%CI: - 0.62 to - 0.17; p < 0.001) and BMI (1-unit; ß: - 0.59; 95%CI: - 0.98 to - 0.20; p = 0.004) at time of injury were associated with worse PROMIS-PF scores and longer follow-up (1-year; ß: 0.79; 95% CI: 0.27 to 1.3; p = 0.004) with better scores.
CONCLUSION
One in 8 young patients with a distal femur fracture underwent reoperation for nonunion and one in 33 for FRI. Physical function scores were marginally lower than the reference population, whereas depression and anxiety scores were similar. The finding that physical function scores were more influenced by baseline patient factors than injury characteristics is important for prognostication and patient education. These results should be interpreted in the context of the small sample size, and future research with larger cohorts is needed to confirm these findings and better understand long-term functional outcomes in young patients following treatment of distal femur fractures.
目的
描述年轻患者股骨远端骨折手术治疗后的骨不连和骨折相关感染（FRI）发生率以及患者报告的结局。
方法
我们回顾性确定了2006年至2023年间在两家一级创伤中心接受股骨远端骨折手术治疗且临床随访≥3个月的所有患者（年龄18 - 50岁）。结局包括因骨不连和FRI进行的再次手术；以及患者报告结果测量信息系统（PROMIS）身体功能（PF）、抑郁和焦虑（参考人群均值：50）。进行多元线性回归以确定与PROMIS - PF相关的因素。
结果
86例患者符合纳入标准。中位年龄为34岁，71%为男性，42%为开放性骨折，38例患者在治疗后平均9.8年收集了PROMIS评分。11例患者（13%）因骨不连需要再次手术，3例（3.5%）因FRI需要再次手术。PROMIS - PF的中位数为47.0（四分位间距：41.2 - 52.4），抑郁为45.8（四分位间距：38.9 - 53.6），焦虑为46.7（四分位间距：39.5 - 60.5）。PROMIS - PF低于参考人群评分（p < 0.05）。受伤时年龄增加（1岁；β： - 0.39；95%置信区间： - 0.62至 - 0.17；p < 0.001）和体重指数（BMI）增加（1个单位；β： - 0.59；95%置信区间： - 0.98至 - 0.20；p = 0.004）与更差的PROMIS - PF评分相关，而更长的随访时间（一年；β：0.79；95%置信区间：0.27至1.3；p = 0.004）与更好的评分相关。
结论
8名年轻股骨远端骨折患者中有1人因骨不连接受再次手术，33人中有1人因FRI接受再次手术。身体功能评分略低于参考人群，而抑郁和焦虑评分相似。身体功能评分受基线患者因素而非损伤特征影响更大这一发现对于预后评估和患者教育很重要。这些结果应结合小样本量的情况进行解释，需要更大队列的未来研究来证实这些发现并更好地了解年轻患者股骨远端骨折治疗后的长期功能结局。
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