首页|创伤性胸腰椎爆裂骨折患者内固定术后重返岗位因素分析

创伤性胸腰椎爆裂骨折患者内固定术后重返岗位因素分析

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目的 分析创伤性胸腰椎爆裂骨折患者行内固定术后重返工作岗位(return to work,RTW)的危险因素.方法 选取 2021 年 5 月至 2023 年 5 月在我院治疗的 182 例创伤性胸腰椎爆裂骨折患者.收集人口学、职业以及临床 3 个方面的因素,对患者进行特征分析和一般临床资料比较,并采用多因素 Logistic 回归分析创伤性胸腰椎爆裂骨折患者行内固定术后 RTW 的独立危险因素.结果 182 例患者 1 年内术后 RTW 率为 76.9%(140 例),其中术后 3 个月内、3～6 个月、6～12 个月分别为 4.9%(9 例)、38.5%(70 例)、33.5%(61 例);此外,术后未 RTW 率 23.1%(42 例),原因包括慢性疼痛 16 例(38.1%),行动不便、力量和耐力下降 11 例(26.2%),无法胜任既往工作性质和工作环境 10 例(23.8%),抑郁症 5 例(11.9%).未 RTW 患者教育程度(研究生)比例、格拉斯哥昏迷评分(Glasgow coma scale,GCS)低于 RTW 患者,年龄、性别(男)、职业(重体力工作)、并发症比例、查尔森合并症指数(Charlson comorbidity index,CCI)、受伤严重程度评分(injury severity score,ISS)比例、骨折椎体数(多发)和骨折机制(道路交通事故)比例以及疼痛视觉模拟评分(visual analogue score,VAS)高于 RTW 患者(P<0.05).多因素 Logistic 回归显示:年龄[OR(95%CI)1.010(1.001～1.318)]、教育程度:专科及本科[OR(95%CI)0.844(0.646～0.934)]和研究生[OR(95%CI)0.823(0.673～0.974)]、ISS:重伤[OR(95%CI)1.235(1.132～1.586)]和严重伤[OR(95%CI)1.422(1.234～1.954)]、骨折机制[OR(95%CI)1.543(1.276～2.053)]和 VAS 评分[OR(95%CI)1.532(1.321～2.003)]与患者未 RTW 风险独立相关(P<0.05).结论 创伤性胸腰椎爆裂骨折患者年龄、教育程度、损伤严重程度、骨折机制、疼痛与未 RTW风险相关,关注这些风险变量并采取更为积极的术后措施将有助于促使患者 RTW.
Analysis of return to work factors after internal fixation for patients with traumatic thoracolumbar burst fractures
Objective To analyse risk factors for return to work(RTW)after internal fixation for patients with traumatic thoracolumbar burst fractures.Methods 182 patients with traumatic thoracolumbar burst fractures treated at our hospital from May 2021 to May 2023 were selected.Demographic,occupational,and clinical factors were collected and analyzed.Multifactorial logistic regression was used to analyze the independent risk factors for RTW after internal fixation for patients with traumatic thoracolumbar burst fractures.Results The postoperative RTW rate within 1 year in 182 patients was 76.9%(140 cases),of which 4.9%(9 cases),38.5%(70 cases),and 33.5%(61 cases)were within 3 months,3-6 months,and 6-12 months after surgery,respectively;in addition,the postoperative failure to RTW rate was 23.1%(42 cases).The reasons included chronic pain in 16 cases(38.1%),mobility problems,strength and endurance decrease in 11 cases(26.2%),inability for previous work and work environment in 10 cases(23.8%),and depression in 5 cases(11.9%).The proportion of education(postgraduate)and GCS were lower in the non-RTW patients than in the RTW patient.The age,sex(male),occupation(heavy work),comorbidities,CCIs,ISS,the number of fractured vertebrae(multiple),mechanism of fracture(road traffic accidents)and VAS were higher than those of the RTW patients(P<0.05).Multifactorial logistic regression showed that age,education,ISS,fracture mechanism and VAS were independently associated with non-RTW risk independently(P<0.05).Age:[OR(95%CI)1.010(1.001-1.318)];education:specialist and undergraduate[OR(95%CI)0.844(0.646-0.934)],postgraduate[OR(95%CI)0.823(0.673-0.974)];ISS:serious injury[OR(95%CI)1.235(1.132-1.586)],severe injury[OR(95%CI)1.422(1.234-1.954)];fracture mechanism[OR(95%CI)1.543(1.276-2.053)];VAS[OR(95%CI)1.532(1.321-2.003)].Conclusions Age,education,injury severity,fracture mechanism,and pain are associated with the risk of non-RTW for patients with traumatic thoracolumbar burst fractures.Attentions to these risk variables and more aggressive postoperative measures will help prompt RTW.

Wounds and injuriesSpinal fracturesFracture fixation,internal

黄燕、黄霞、徐丽红、王佳蕾、褚春香

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215600 江苏省,南京中医药大学张家港附属医院(张家港市中医医院)骨伤科

215600 江苏省,张家港市人民医院骨科

创伤和损伤 脊柱骨折 骨折固定术,内

2024

10.3969/j.issn.2095-252X.2024.10.015

中国骨与关节杂志
中国医疗保健国际交流促进会，北京中科康辰骨关节伤病研究所

中国骨与关节杂志

CSTPCD
影响因子：0.665
ISSN：2095-252X
年,卷(期)：2024.13(10)