切开复位与闭合复位内固定治疗不稳定型骨盆骨折长期预后的多中心队列研究  

Open versus closed reduction and internal fixation in treatment of unstable pelvic fractures: a multicenter cohort study of long-term prognosis

作　　者：齐红哲 张伟[1,3] 李嘉琦 毕争 曹文豪 王中鹤 周雪峰 陈华 唐佩福[1,4] Qi Hongzhe;Zhang Wei;Li Jiaqi;Bi Zheng;Cao Wenhao;Wang Zhonghe;Zhou Xuefeng;Chen Hua;Tang Peifu(Department of Othopaedics,The Fourth Medical Center,General Hospital of Chinese PLA,Beijing 100048,China;?Department of Othopaedics,Strategic Support Force Specialty Medical Center,Bejing 10010l,China;School of Sports Engineering,Beijing Sports University,Bejing 100084,China;National Clinical Research Center for Orthopaedics,Sports Medicine&Medicine,Beijing 100853,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100048 [2]战略支援部队特色医学中心骨科,北京100101 [3]北京体育大学体育工程学院,北京100084 [4]国家骨科与运动康复临床医学研究中心,北京100853

出　　处：《中华创伤骨科杂志》2023年第6期485-490,共6页Chinese Journal of Orthopaedic Trauma

基　　金：军队医学科技青年培育计划(拔尖)项目(21QNPY131);军队后勤科技成果扩试项目(145BHQ0003074X);科技创新2030-新一代人工智能重大项目(2021ZD0140410);科技部国家重点研发项目(2016YFE0126200)。

摘　　要：目的比较切开复位与闭合复位内固定治疗不稳定型骨盆骨折的长期预后结果。方法回顾性分析2011年3月至2017年3月期间解放军总医院第一医学中心、解放军总医院第四医学中心、战略支援部队特色医学中心骨科连续收治的402例不稳定型骨盆骨折患者资料,根据骨折复位方式不同分为两组:切开组194例,男133例,女61例;年龄为43.0(30.7,51.0)岁;骨折Tile分型:B型35例,C型159例;采用切开复位内固定治疗。闭合组208例,男115例,女93例;年龄为45.5(32.0,56.0)岁;骨折Tile分型:B型40例,C型168例;采用闭合复位内固定治疗。比较两组患者末次随访时的健康相关生活质量SF-12评分[包括生理总评分(PCS)和心理总评分(MCS)],以及受伤至手术时间、术中X线透视次数、术中及术后输血量、手术时间、术后骨折复位质量等。结果两组患者除性别外,其他术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。402例患者术后获7.8(6.2,8.8)年随访。末次随访时闭合组患者PCS[49.9(45.4,55.4)分]、MCS[53.1(46.4,57.6)分]显著高于切开组患者[48.2(41.4,52.7)、46.5(40.6,53.6)分],差异均有统计学意义(P<0.05)。闭合组患者的受伤至手术时间[6(5,8)d]、手术时间[180(126,260)min]显著短于切开组患者[9(6,13)d、240(165,334)min],术中及术后输血量[1.5(0,4.0)U]显著少于切开组患者[5.0(2.9,8.0)U],术中X线透视次数[104.5(85.0,132.0)次]显著多于切开组患者[21.0(18.0,26.0)次],术后骨折复位优良率(92.8%,193/208)显著高于切开组患者(86.6%,168/194),差异均有统计学意义(P<0.05)。结论与切开复位内固定相比,闭合复位内固定不仅能够明显缩短患者术前等待时间和手术时间、减少输血量,而且能够获得更好的骨折复位,最终改善患者生活质量。Objective To compare the long-term prognosis between open versus closed reduction and internal fixation in the treatment of unstable pelvic fractures.Methods The data of 402 consecutive patients with unstable pelvic fracture were retrospectively analyzed who had been treated at The First Medical Center and The Fourth Medical Center,PLA General Hospital,and Strategic Support Force Specialty Medical Center from March 2011 to March 2017.This cohort was divided into 2 groups according to the reduction methods.In the open group of 194 cases subjected to open reduction and internal fixation,there were 133 males and 61 females with a median age of 43.0(30.7,51.0)years,and 35 cases of type B and 159 cases of type C by the Tile classification.In the closed group of 208 cases subjected to closed reduction and internal fixation,there were 115 males and 93 females with a median age of 45.5(32.0,56.0)years,and 40 cases of type B and 168 cases of type C by the Tile classification.The 2 groups were compared in terms of 12-items Short Form Health Survey(SF-12)scores[physical component summary(PCS)and mental component summary(MCS)]at the last follow-up,time from injury to operation,frequency of intraoperative X-ray fluoroscopy,intraoperative and postoperative blood transfusion,operation time,and quality of postoperative fracture reduction.Results There was no statistically significant difference between the 2 groups in the preoperative general data except for the gender,showing the 2 groups were comparable(P>0.05).This cohort of 402 patients was followed up for 7.8(6.2,8.8)years.At the last follow-up,the PCS[49.9(45.4,55.4)points]and MCS[53.1(46.4,57.6)points]in the closed group were significantly higher than those in the open group[48.2(41.4,52.7)and 46.5(40.6,53.6)points](P<0.05).The closed group incurred significantly shorter time from injury to operation[6(5,8)d]and operation time[180(126,260)min]than the open group[9(6,13)d and 240(165,334)min],significantly less intraoperative and postoperative blood transfusion[1.5(0,4.0)U

关 键 词：骨盆 骨折 骨折复位 生活质量 长期预后 

分 类 号：R687.3[医药卫生—骨科学]