背景和目的:髋臼骨折的治疗旨在从解剖学上减少和固定所有移位或不稳定的骨折,因为已经证明骨折复位的准确性与临床结果密切相关。然而,关于髋臼骨折患者的围手术期和术后护理的文献中存在明显的差距,这最终可能是不良结局和永久性残疾的潜在风险因素。本研究旨在系统地回顾有关康复实践的现有文献,包括承重协议,在手术治疗的髋臼骨折患者的不同时间点,并将这些实践与功能结局相关联。方法:我们根据系统评估和荟萃分析(PRISMA)指南的首选报告项目,系统地审查了Medline和PubMed数据库以及Cochrane中央对照试验注册。纳入标准是对成年患者(19岁以上)的研究,过去10年的出版物,专注于康复或提及与康复有关的任何方面(例如负重或肌肉训练)的文章,并描述了急性的外科治疗,孤立的髋臼骨折.收集了具体信息,包括骨折分类,手术时间到了,手术方法,手术时间,失血,固定策略,还原质量,术后康复方案,并发症发生率,并发症类型,和结果测量(S)。手术方法的选择,手术时间,失血,并根据骨折分类对固定策略进行分层。计算所有研究的并发症发生率和并发症类型。根据Letournel分类对骨折进行分类。结果:初步检索共494篇,其中22例(1025例)纳入最终审查.最常见的康复方案是在术后第一天开始进行等距股四头肌和外展肌强化锻炼,术后1-3天被动髋关节运动,术后第一天至术后4周主动髋关节运动。手术后1至12周,允许使用助行器或拐杖进行部分承重,根据患者的一般情况和骨折愈合状态(通常在3个月结束时),允许完全负重。仅在三项研究中,患者在术后早期(≤1周)开始负重。由于报道术后≤1周和>1周负重方案的研究之间的差异,未进行荟萃回归分析。结论:我们的研究表明,加速术后康复方案,包括早期允许的负重,似乎不会增加髋臼骨折手术治疗后复位丢失的风险或并发症的发生率。然而,适当的荟萃分析是不可能的,纳入研究的异质性使我们无法就功能结果得出任何与该康复方案相关的潜在生物力学和临床益处或负面影响的结论.与受限制的承重方案相比,PROM的使用不一致,无法客观地计算加速方案的影响大小。我们提出需要更高层次的证据来证明我们的假设。
Background and Objectives: Management of
acetabular fractures is aimed at anatomically reducing and fixing all displaced or unstable fractures, as the accuracy of fracture reduction has been demonstrated to strongly correlate with clinical outcomes. However, there is a noticeable gap in the literature concerning the perioperative and postoperative care of patients with
acetabular fractures, which ultimately can be potential risk factors for adverse outcomes and permanent disabilities. This study aimed to systematically review the available literature regarding rehabilitation practices, including weight-bearing protocols, across time points in surgically treated
acetabular fracture patients and correlate these practices with functional outcomes. Methods: We systematically reviewed the Medline and PubMed databases and the Cochrane Central Register of Controlled Trials in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were studies with adult patients (19+ years), publications from the last 10 years, articles focusing on rehabilitation or mentioning any aspect related to rehabilitation (such as weight-bearing or muscle training), and describing the surgical management of acute, isolated acetabulum fractures. Specific information was collected, including the fracture classification, time to surgery, surgical approach, surgical time, blood loss, fixation strategy, quality of reduction, postoperative rehabilitation protocol, complication rate, type(s) of complication, and outcome measurement(s). The choice(s) of surgical approach, surgical time, blood loss, and fixation strategy were stratified based on the fracture classification. The complication rate and type(s) of complication were calculated for all studies. Fractures were classified based on the Letournel classification. Results: A total of 494 articles were identified from the initial search, of which 22 (1025 patients) were included in the final review. The most common rehabilitation protocol favored isometric quadriceps and abductor strengthening exercises starting on the first postoperative day, with passive hip movement at 1-3 days postoperatively and active hip movement ranging from the first postoperative day to 4 weeks postoperatively. Partial weight-bearing with a walker or a pair of crutches was permitted from 1 to 12 weeks after surgery, and full weight-bearing was allowed depending on the patient\'s general condition and fracture healing state (generally at the end of 3 months). In only three studies did the patients start bearing weight in the early postoperative period (≤1 week). Meta-regression analysis was not performed due to the discrepancy between studies that reported a weight-bearing protocol ≤1 week and >1 week postoperatively. Conclusions: Our study suggests that an accelerated postoperative rehabilitation protocol, including early permissive weight-bearing, does not appear to increase the risk of loss of reduction or the rate of complications after surgical treatment of
acetabular fractures. However, a proper meta-analysis was not possible, and the heterogeneity of the included studies did not allow us to conclude anything about the potential biomechanical and clinical benefits nor the negative effects related to this rehabilitation regimen in terms of functional results. There is an inconsistent use of PROMs for objectively calculating the effect size of the accelerated protocol compared with restricted weight-bearing regimes. We pose the need for higher-level evidence to proof our hypothesis.