目的:本回顾性研究旨在分析患者特征,围手术期并发症,和手术治疗骨盆脆性骨折(FFP)的短期结果。
方法:我们选择了42例患者,这些患者在2019年10月至2022年10月期间接受了FFP手术,并可在术后随访6个月以上。包括一名男性患者和41名女性患者,平均年龄为83.5(65-96)岁。收集了以下人口统计数据:罗马人分类,手术方法,再手术率,植入物松动,围手术期并发症,介入放射学(IVR)适应症率,围手术期输血指征率,手术前和最终随访时的Parker流动性评分(PMS),术前和术后第3天的数字评定量表(NRS)评分。
结果:Rommens分类如下:IIa型(n=2),IIb型(n=13),IIIa型(n=8),IIIc型(n=3),IVb型(n=13),和IVc型(n=3)。对于外科手术,35例(83.3%)患者单纯经皮螺钉内固定成功,7例患者进一步需要开放钢板固定。16例(38.1%)患者出现种植体松动,包括轻微案件,1例患者需要移除植入物。6例患者的术中并发症是螺钉的轻微穿孔;没有神经症状的患者。受伤的时候,3例(7.1%)因出血而指示IVR。30例患者(71.4%)在入院时出现了医学并发症。一名患者因术后肺炎死亡。受伤前和最终随访时的平均PMS分别为6.51分和5.38分,分别。手术前和术后第3天的平均NRS评分分别为5.26和3.49,显着改善(p<0.01)。
结论:我们回顾性分析了42例需要FFP手术的患者。超过80%的病例可以通过经皮螺钉固定治疗,但在受伤时考虑失血性休克和IVR的适应症总是很重要的。38.1%的患者出现种植体松动,包括轻微案件,并被认为是未来需要改进的问题,例如通过使用水泥增强。术后第3天平均NRS评分相对于术前平均评分显著改善。这表明手术可能有助于早期动员。
OBJECTIVE: The present retrospective study aimed to analyze patient characteristics, perioperative complications, and short-term outcomes of surgery for fragility fractures of the pelvis (FFP).
METHODS: We selected 42 patients who underwent surgery for FFP between October 2019 and October 2022 and could be followed for more than 6 months postoperatively, including one male patient and 41 female patients with an average age of 83.5 (65-96) years. The following demographic data were collected: Rommens classification, surgical method, reoperation rate, implant loosening, perioperative complications, interventional radiology (IVR) indication rate, perioperative blood transfusion indication rate, Parker Mobility Score (PMS) before surgery and at final follow-up, and numerical rating scale (NRS) score before surgery and on day 3 postoperatively.
RESULTS: Rommens classification was as follows: type IIa (n = 2), type IIb (n = 13), type IIIa (n = 8), type IIIc (n = 3), type IVb (n = 13), and type IVc (n = 3). For surgical procedure, 35 patients (83.3%) were successfully stabilized with percutaneous screw fixation alone, and 7 patients further required open plate fixation. Implant loosening was observed in 16 patients (38.1%), including minor cases, and implant removal was required in 1 patient. Minor perforation of the screw was observed as an intraoperative complication in 6 patients; there were no patients with neurological symptoms. At the time of injury, IVR was indicated in 3 patients (7.1%) because of hemorrhage. Thirty patients (71.4%) had medical complications at the time of admission. One patient died due to postoperative pneumonia. Mean PMS before injury and at final follow-up were 6.51 points and 5.38 points, respectively. Mean NRS scores before surgery and on day 3 postoperatively were 5.26 and 3.49, respectively, showing a significant improvement (p < 0.01).
CONCLUSIONS: We retrospectively reviewed 42 patients who required surgery for FFP. More than 80% of cases could be treated with percutaneous screw fixation, but it is always important to consider hemorrhagic shock at the time of injury and indications for IVR. Implant loosening was observed in 38.1% of patients, including minor cases, and was considered an issue to be improved on in the future, such as by using cement augmentation. A significant improvement in mean NRS score on day 3 postoperatively relative to the mean preoperative score was observed, suggesting that surgery may contribute to early mobilization.