Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature.
Treatment of Lower Extremity Fractures in Chronic Spinal Cord Injury: A Systematic Review of the Literature.
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慢性脊髓损伤下肢骨折的治疗：文献的系统回顾。
DOI：
10.1002/pmrj.12428
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Carbone,LauraD
中科院分区：
文献类型：
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作者：
Huang,Donna;Weaver,Frances;Obremskey,WilliamT;Ahn,Jaimo;Peterson,Kimberly;Anderson,Johanna;Veazie,Stephanie;Carbone,LauraD
目的回顾有关慢性脊髓损伤（SCI）下肢（LE）骨折手术和非手术治疗结局的文献。类型系统评价、文献调查Medline（PubMed）、Embase、科克伦系统评价数据库、科克伦中心、护理和相关健康文献累积索引、ClinicalTrials.gov、国际临床试验注册平台、和国际标准随机对照试验的检索时间为1966年1月1日至2019年3月1日。方法检索仅限于英语和成人（年龄≥ 18岁）。审查标题和摘要与纳入研究主题的相关性。排除了病例报告、综述、非SCI人群研究和检查急性SCI时骨折的研究。原始检索和工作组以及外部提交文献中纳入的文献的参考文献产生了另外两篇文献，经工作组成员投票后纳入审查。由四名工作队成员使用Microsoft Excel中创建的数据提取表、术语表和说明进行数据提取。由三位方法学家使用预先规定的标准进行质量评估。手术治疗慢性SCI患者下肢骨折的病例越来越多，但非手术治疗的报道仍然越来越多。无论何种治疗类型，截肢、骨不连/畸形愈合和压力损伤是最常报告的并发症。功能和生活质量的outcome.ConclusionsThere是不够的证据来支持手术与非手术治疗的最佳实践LE骨折SCI的管理。现有文献受到样本量小、缺乏随机化或匹配的研究设计、研究人群和治疗策略的显著异质性以及定义和报告关注结局的变异性的限制。该领域将受益于未来的研究，以解决研究设计问题和结果报告的标准化，以促进手术与非手术治疗结果的比较。
ObjectiveTo review the literature regarding outcomes of surgical and nonsurgical management of lower extremity (LE) fractures in chronic spinal cord injury (SCI).TypeSystematic review.Literature SurveyMedline (PubMed), Embase, Cochrane Database of Systemic Reviews, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trials were searched from January 1, 1966, to March 1, 2019.MethodologySearch was restricted to English language and adults (age ≥ 18 yr). Titles and abstracts were reviewed for relevance to study topics for inclusion. Case reports, reviews, non‐SCI population studies, and studies examining fractures at the time of acute SCI were excluded. References of included articles from the original search and task force and external submissions yielded two additional articles that were included in the review after voting by task force members. Data extraction was performed by four task force members using a data extraction form, glossary, and instructions created in Microsoft Excel. Quality assessment was performed by three methodologists using prespecified criteria.SynthesisTwenty‐three articles were included. Use of surgery to treat LE fractures in chronic SCI has increased, though nonoperative management was still more frequently reported. Regardless of type of management, amputations, nonunion/malunion, and pressure injuries were among the most commonly reported complications. Functional and quality of life outcomes were less frequently reported.ConclusionsThere is insufficient evidence to support operative versus nonoperative management as best practice for management of LE fracture of SCI. Existing literature was limited by small sample sizes, lack of randomization or matched study designs, significant heterogeneity in populations and treatment strategies studied, and variability in defining and reporting outcomes of interest. The field would benefit from future research to address study design issues and standardization of outcome reporting to facilitate comparison of outcomes of operative versus nonoperative management.