The Epidemiology and Injury Patterns of Acetabular Fractures: Are the USA and China Comparable?
The Epidemiology and Injury Patterns of Acetabular Fractures: Are the USA and China Comparable?
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DOI：
10.1007/s11999-014-3462-8
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发表时间：
2014-11-01
影响因子：
4.2
通讯作者：
Smith, Wade
中科院分区：
文献类型：
--
作者：
Mauffrey, Cyril;Hao, Jiandong;Smith, Wade
髋臼骨折是异质患者群体中罕见的损伤，因此很难在美国或欧洲开展足够有力的前瞻性单中心临床试验。中国创伤中心治疗大量此类损伤，如果患者人数和损伤模式与美国相当，这可能支持两国一级创伤中心开展多中心研究。我们确定了中国和美国创伤中心治疗的手术髋臼骨折的以下参数是否相似：（1）受伤患者的流行病学，（2）损伤机制和骨折类型，以及 (3)住院时间参数，包括有症状的术后深静脉血栓(DVT)发生率。我们从创伤数据库中提取了2005年至2012年中国一家中心和2008年至2012年美国一家中心接受手术治疗的髋臼骨折患者的数据。分析性别、年龄、损伤机制、骨折分类、损伤严重程度评分（ISS）、受伤至手术时间、住院时间和有症状 DVT 发生率。我们纳入了 661 名中国患者（539 名男性，122 名女性）和 212 名美国患者（163 名男性，49 名女性）。中国和美国受伤时的平均年龄不同，单峰分布为 40 岁，双峰分布为 44 岁（p < 0.001）。在中国，手术治疗髋臼骨折的发生率一直在上升，但在美国却在下降。平均国际空间站具有可比性。尽管损伤机制的分布不同 (p = 0.004)，但高能量损伤（机动车事故、跌落 > 10 英尺）仍然是两个中心骨折的主要原因。骨折分类（根据 Letournel）具有可比性，其中后壁骨折最常见。中国从受伤到手术的平均时间和平均住院时间比美国长（分别为 9 天与 3 天 [p < 0.001] 和 26 天与 11 天 [p < 0.001]）。有症状的 DVT 发生率具有可比性。虽然我们发现了两个中心之间的差异，但我们也注意到了重要的相似之处。涉及这些地点的多中心临床研究应谨慎进行，并关注相似的终点，同时考虑到人群的基线差异。由于存在这种差异的可能性，这种验证研究应该在开始资源密集型多中心试验之前进行。III级，治疗研究。有关证据级别的完整描述，请参阅作者须知。
Acetabular fractures are rare injuries in heterogeneous patient groups, making it difficult to develop adequately powered prospective single-center clinical trials in the USA or Europe. Chinese trauma centers treat a high volume of these injuries, and if the patient population and injury patterns are comparable to those in the USA, this might support development of multicenter studies in Level I trauma centers in the two countries.We determined whether the following parameters were similar between operative acetabular fractures treated at Chinese and US trauma centers: (1) epidemiology of injured patients, (2) mechanism of injuries and fracture types, and (3) hospital stay parameters, including symptomatic postoperative deep vein thrombosis (DVT) rate.We extracted data from trauma databases for patients admitted with acetabular fractures managed surgically from 2005 to 2012 for one Chinese center and from 2008 to 2012 for one US center. Sex, age, mechanism of injury, fracture classification, Injury Severity Score (ISS), time from injury to surgery, length of hospital stay, and symptomatic DVT rate were analyzed. We included 661 Chinese patients (539 men, 122 women) and 212 US patients (163 men, 49 women).Mean age at time of injury was different between China and the USA, at 40 years with a unimodal distribution and 44 years with a bimodal distribution (p < 0.001), respectively. Incidence of surgically treated acetabular fractures has been increasing in China but decreasing in the USA. Mean ISSs were comparable. Although the distribution of mechanisms of injury was different (p = 0.004), high-energy injuries (motor vehicle accidents, falls > 10 feet) still accounted for most fractures in both centers. Fracture classifications (per Letournel) were comparable, with posterior wall fractures most common. Mean time from injury to surgery and mean hospital stay were longer in China than in the USA (9 versus 3 days [p < 0.001] and 26 versus 11 days [p < 0.001], respectively). Symptomatic DVT rates were comparable.Although we identified differences between the two centers, we also noted important similarities. Multicenter clinical studies involving these locations should be performed with caution and focus on similar end points, taking into account the populations' baseline differences. Because of the potential for such differences, this kind of validation study should be performed before embarking on resource-intensive multicenter trials.Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.