背景:对于髋部后骨折脱位,目前的共识是在6小时内进行关节复位,以防止后遗症。然而,是否应在急诊科(ED)或手术室(OT)进行闭合复位(CR)仍有争议。我们旨在评估髋关节后骨折脱位患者在ED时CR失败的发生率和预测因素。
方法:纳入2009年至2019年的髋关节后骨折脱位患者。年龄,性别,体重指数(BMI),损伤严重程度评分,新损伤严重程度评分,从受伤到第一次尝试复位的时间(TIR),存在相关的股骨头骨折,后壁边缘嵌塞,比较CR成功患者和CR失败患者的后壁碎片大小。
结果:55例髋部后骨折脱位患者在ED中经历了CR尝试,并被纳入研究。在ED中成功减少了38(69.1%)臀部,17人(30.9%)经历了失败。年龄无显著差异,性别,BMI,股骨头骨折的存在,边缘撞击,或在组间发现后壁碎片的大小。成功CR组的TIR明显缩短(2.24vs.4.11h,p=0.01)。根据接收机工作特性曲线分析,3.5h是截止时间。
结论:对于髋部后骨折脱位患者,TIR是成功CR的关键因素。如果受伤后的时间间隔超过3.5h,床旁CR在急诊室的成功率可能会降低,如果床边CR失败,应准备OT。
方法:
BACKGROUND: For hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation.
METHODS: Patients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED.
RESULTS: Fifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time.
CONCLUSIONS: For patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR.
METHODS: