背景:通过深入了解生活质量(QoL)状况和并发症的发生,骨折相关感染(FRI)患者护理中的关键方面可以得到缓解,并且可以采取措施改善其预后.因此,本研究的目的是1)确定FRI患者与非FRI患者的QoL,2)描述FRI和非FRI患者其他并发症的发生情况.
方法:一项双向队列研究于2016年1月1日至2021年11月1日在1级创伤中心进行。所有接受孤立的长骨骨折手术稳定的患者都有资格入选。为了避免混淆,仅包括损伤严重度评分(ISS)<16的患者。有关患者人口统计的数据,断裂特征,治疗,收集非FRI和FRI患者的随访和并发症.QoL是通过使用受伤后12个月的五级EuroQol五维(EQ-5D-5L)问卷进行评估的。
结果:本研究共纳入134例患者,其中38例(28%)FRI患者和96例(72%)非FRI患者。与非FRI患者相比,FRI患者在QoL评估中关于指数值(p=0.012)和域移动性(p<0.001)的得分明显更差,正常活动(p=0.010)和疼痛/不适(p=0.009)。其他术后并发症在FRI患者中更常见(p<0.001)(66%,n=25/38)与非FRI患者(27%,n=26/96)。在14.5个月的中位随访期间(四分位距(IQR)9.5-26.5),除FRI外,25名FRI患者共出现49种独特的并发症。并发症骨不连(18%,n=9/49),FRI以外的感染(例如,线感染,尿路感染,肺炎)(18%,n=9/49)和植入物失败(14%,n=7/49)是FRI组中最常见的描述。
结论:患有FRI的患者与没有FRI的患者相比,QoL降低。此外,FRI患者的额外并发症发生率较高.这些发现可以帮助患者咨询有关因感染而导致复杂康复过程的潜在身心后果。
BACKGROUND: By gaining insight into the Quality of Life (QoL) status and occurrence of complications, critical facets in the care for patients with Fracture-Related Infection (FRI) can be mitigated and measures can be taken to improve their outcome. Therefore, the aims of this study were to 1) determine the QoL in FRI patients in comparison to non-FRI patients and 2) describe the occurrence of other complications in both FRI and non-FRI patients.
METHODS: An ambidirectional cohort study was conducted in a level 1 trauma centre between January 1st 2016 and November 1st 2021. All patients who underwent surgical stabilisation of an isolated long bone fracture were eligible for inclusion. To avoid confounding, only patients with an Injury Severity Score (ISS) <16 were included. Data regarding patient demographics, fracture characteristics, treatment, follow-up and complications were collected of both non-FRI and FRI patients. QoL was assessed through the use of five-level EuroQol five-dimension (EQ-5D-5L) questionnaires twelve months post-injury.
RESULTS: A total of 134 patients were included in this study, of whom 38 (28%) FRI patients and 96 (72%) non-FRI patients. In comparison to non-FRI patients, FRI patients scored significantly worse on the QoL assessment regarding the index value (p = 0.012) and the domains mobility (p<0.001), usual activities (p = 0.010) and pain/discomfort (p = 0.009). Other postoperative complications were more often reported (p<0.001) in FRI patients (66%, n = 25/38) compared to non-FRI patients (27%, n = 26/96). During the median follow-up of 14.5 months (interquartile range (IQR) 9.5-26.5), 25 FRI patients developed a total of 49 distinctive complications besides FRI. The complications nonunion (18%, n = 9/49), infection other than FRI (e.g. line infection, urinary tract infection, pneumonia) (18%, n = 9/49) and implant failure (14%, n = 7/49) were the most frequently described in the FRI group.
CONCLUSIONS: Patients who suffered from an FRI have a decreased QoL in comparison to those without an FRI. Moreover, patients with an FRI have a higher rate of additional complications. These findings can help in patient counselling regarding the potential physical and mental consequences of having a complicated course of recovery due to an infection.