APC Injuries With Symphyseal Fixation: What Affects Outcome?

作者：Lybrand Kyle; Bell Anthony; Rodericks Deirdre; Templeman David; Tornetta Paul III^*

来源：Journal of Orthopaedic Trauma, 2017, 31(1): 27-30.

DOI：10.1097/BOT.0000000000000734

• pelvis fracture
• symphyseal disruption
• symphyseal fixation
• implant failure
• functional outcomes

Objective: To evaluate the influence of the symphyseal position at union, implant failure, and the type of posterior ring injury on validated outcome measures.
Design: Retrospective review with prospectively collected validated outcome data.
Setting: Two academic level 1 trauma centers.
Patients/Participants: We evaluated 54 patients with operatively treated anterior-posterior compression (APC) type 2 and 3 injuries.
Intervention: Thirty-five APC type 2 and 19 APC type 3 injuries were reviewed at a minimum of 2 years after surgery. Average follow-up was 7 years.
Main Outcome Measures: Patients were evaluated with validated EuroQol five dimensions (EQ5D), EuroQol health index, Visual Analog Score (VAS) pain, Majeed pelvic scores, and change in work status. The final anterior-posterior (AP) radiograph available was reviewed for implant failure and displacement. Revision surgery was documented based on implant status and displacement at final follow-up.
Results: There were trends toward better outcomes for APC type 2 for EQ5D and VAS pain. Patients with injury severity score (ISS).16 had worse reported health, Majeed scores, and VAS pain. Nineteen patients had failure of fixation. There were no differences in any outcome measure; trends toward better Majeed score were found for patients with intact fixation. Displacements >15 mm anteriorly at final follow-up negatively affect outcomes with significantly worse EQ5D, reported health, and Majeed score. Two patients required revision surgery. There were no differences in final outcomes.
Conclusions: No significant differences were found for APC type 2 versus type 3 injuries. Higher injury severity score resulted in worse outcomes and more pain. Outcomes were not effected by implant failure; however, major loss of reduction (>15 mm) anteriorly did negatively impact outcomes. Patients with failure who were revised to union did not have worse outcomes.

• 出版日期2017-1