Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2011; 78(2):120-125 | DOI: 10.55095/achot2011/019

Multicentrická studie pacientů s poraněním pánve: přehled klinických výsledků a trvalých následkůPůvodní práce

V. DŽUPA^1+2,*, J. CHMELOVÁ¹⁺³, T. PAVELKA¹⁺⁴, P. OBRUBA¹⁺⁵, P. WENDSCHE¹⁺⁶, P. ŠIMKO¹⁺⁷, CISP Investigators^*

¹ Centrum pro integrované studium pánve 3. LF UK, Praha

² Ortopedicko-traumatologická klinika 3. LF UK a FNKV, Praha

³ Radiodiagnostický ústav FNsP, Ostrava

⁴ Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FNsP, Plzeň

⁵ Traumacentrum Masarykovy nemocnice, Ústí nad Labem

⁶ Klinika traumatologie, Úrazová nemocnice, Brno

⁷ Traumatologická klinika, Lekárska fakulta SZU a UN, Bratislava

^* CISP Investigators jsou spolupracovníci Centra pro integrované studium pánve 3. LF UK v Praze, kteří se podíleli na studii a jejich seznam je uveden níže

PURPOSE OF THE STUDY:
The aim of the study was to assess the clinical outcomes and permanent sequelae of pelvic fractures at one year after injury and to identify factors that influenced these results.

MATERIAL AND METHODS:
The group evaluated consisted of 151 patients older than 15 years treated for pelvic fractures in 2007 at seven hospitals in the Czech Republic and Slovakia. This one-year descriptive prospective study included all basic epidemiological data concerning the patients and the evaluation of their clinical results using the Majeed score. The obtained data were statistically analysed by the χ2 test of independence and contingency tables at a 5% level of significance. For data obtained at a low frequency, only descriptive statistical methods were used.

RESULTS:
From the original group of 237 patients (101 women and 136 men), 16 died (7 women and 9 men) and 70 were lost for follow-up (28 women and 42 men), leaving 151 patients (64%) for evaluation. This final group comprised 66 women (44%) and 85 men (56%) with the age range of 16 to 82 and an average age of 42.7 years (women, 45.3 years; men, 40.7 years). Age distribution, causes of injury, types of pelvic fracture, associated injuries and methods of treatment in this group were similar to those in the original group. The clinical outcomes evaluated using the pelvic Majeed score were excellent and good in 85%, fair in 12% and poor in 3% of the patients. The prediction of clinical outcome was more accurate when based on the extent of dislocation of the dorsal segment after fracture healing than on the type of pelvic fracture.
The permanent sequelae were recorded in 22 patients (15%) and a total of 43 specific complaints were identified; some patients had multiple sequelae involving neurological, urological and sexual problems. Neurological deficit was related to the type of pelvic injury and its highest occurrence was associated with type C pelvic fractures. Permanent neurological deficits were found in 15 patients (10% of patients in the final group), of whom 10 were diagnosed early after injury as having neurological lesions (7% of the final group) and in five the diagnosis was made after surgery (8 %of surgically treated patients). Fifteen permanent urological disorders were recorded in 13 patients and they also were most frequent in type C fractures. However, they were more strongly associated with primary urethral injury and primary or post-operative neurogenic lesions. Sexual sequelae were also found in association with type C fractures; almost all patients with these problems had injury to the lower urinary tract or neurogenic lesions. Permanent gastrointestinal sequelae were in three patients; all of them sustained unstable pelvic fractures and were diagnosed with post-operative neurogenic lesions.

DISCUSSION:
Based on the evaluation of basic patient data, the patient group described here can be regarded as a representative sample of the originally treated patients. Therefore, in the authors' view, the results presented here can be taken as valid.
In agreement with other authors, the study recorded poorer clinical outcomes in the patients with more serious types of pelvic injury, and dramatically worse results in relation to the extent of dislocation of the dorsal segment after the pelvic fracture had healed.
The authors confirmed that permanent neurological and urological sequelae occur more frequently in patients with a more serious pelvic injury. Urological and sexual problems were more often associated with the presence of neurological deficit than with the type of pelvic fracture and injury to the lower urinary tract.

CONCLUSIONS:
The evaluation of patient data at one year after pelvic injury in this prospective longitudinal study justify the authors to draw the following conclusions: clinical outcomes were worse in unstable pelvic fractures; worse clinical results were related to the extent of residual dislocation of the dorsal pelvic segment; permanent neurological sequelae were most frequent and were perceived by the patients with strong negative feelings particularly when they manifested clinically after surgery; permanent urological, sexual and gastrointestinal problems were more closely associated with neurological deficits than with the severity of primary injury to the pelvic skeleton, lower urinary tract, sexual organs or digestive system.

Klíčová slova: pelvic fracture, associated injuries, clinical outcomes, neurological sequelae, urological sequelae, sexual sequelae, gastrointestinal sequelae

Zveřejněno: 1. duben 2011  Zobrazit citaci