MacKenzie E J, Cushing B M, Jurkovich G J, Morris J A, Burgess A R, deLateur B J, McAndrew M P, Swiontkowski M F
Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland.
J Trauma. 1993 Apr;34(4):528-38; discussion 538-9. doi: 10.1097/00005373-199304000-00009.
To determine functional outcomes after lower extremity fracture (LEF), a prospective follow-up study of patients admitted to three level I trauma centers for treatment of unilateral LEFs was conducted. In this paper we describe outcomes at 6 months after discharge from the initial hospitalization and examine the relationship between impairment and disability. A total of 444 patients met the entry criteria for the study. Of these 376 (85%) were successfully located and interviewed at 6 months; 302 (68%) returned to the trauma center at 6 months for a clinical assessment by a physical therapist. Study patients were predominantly young (mean age = 32.4), white (72%) men (70%) who were working before the injury (77%). The fractures resulted primarily from motor vehicle crashes (71%); mean hospital LOS was 12 days. Disability was measured using the Sickness Impact Profile (SIP), a well validated patient assessment of health status. The overall SIP score averaged for all patients was 10.2, denoting a moderate level of dysfunction or disability. Analysis of the 12 subscores that constitute the SIP indicate particularly high scores for ambulation (16.7 postdischarge vs. 1.2 preinjury), sleep and rest (14.0 vs. 5.1), emotional behavior (10.5 vs. 2.2), home management (15.1 vs. 2.6), recreation and pastimes (19.0 vs. 4.4), and most notably, work (33.2 vs. 8.3). Further analysis of the subgroup of patients working before the injury shows that 48% had returned to work at 6 months. Correlations between lower extremity impairment (range of motion, muscle strength, and pain) and the ambulation subscore of the SIP were high. However, correlations between impairment and more global areas of activity such as home management, work, and recreation were considerably lower. These results suggest that other factors, over and above the extent of physical impairment, significantly influence broader disability outcomes such as return to work. Further research is needed to define these factors so that effective interventions after acute care can be identified and appropriately targeted.
为了确定下肢骨折（LEF）后的功能转归，我们对三家一级创伤中心收治的单侧下肢骨折患者进行了一项前瞻性随访研究。在本文中，我们描述了初次住院出院后6个月时的转归情况，并探讨了损伤与残疾之间的关系。共有444例患者符合该研究的纳入标准。其中376例（85%）在6个月时成功找到并接受了访谈；302例（68%）在6个月时返回创伤中心，接受了物理治疗师的临床评估。研究患者主要为年轻患者（平均年龄=32.4岁），白人（72%），男性（70%），受伤前有工作（77%）。骨折主要由机动车碰撞所致（71%）；平均住院时间为12天。使用疾病影响量表（SIP）来衡量残疾情况，这是一种经过充分验证的患者健康状况评估工具。所有患者的SIP总评分平均为10.2，表明功能障碍或残疾程度为中度。对构成SIP的12个分项评分进行分析表明，行走（出院后为16.7，受伤前为1.2）、睡眠和休息（14.0对5.1）、情绪行为（10.5对2.2）、家庭管理（15.1对2.6）、娱乐和消遣（19.0对4.4），最显著的是工作（33.2对8.3）的评分特别高。对受伤前有工作的患者亚组进行进一步分析表明，48%的患者在6个月时已恢复工作。下肢损伤（活动范围、肌肉力量和疼痛）与SIP行走分项评分之间的相关性很高。然而，损伤与家庭管理、工作和娱乐等更广泛活动领域之间的相关性则低得多。这些结果表明，除了身体损伤程度之外，其他因素对诸如恢复工作等更广泛的残疾转归有显著影响。需要进一步研究来确定这些因素，以便能够识别急性护理后的有效干预措施并进行适当的针对性治疗。
