Segmental Femur Kırıklarının Başarılı Tedavi Sonrasında Sağlıkla İlişkili Yaşam Kalitesinin Değerlendirilmesi

Öz

AMAÇ: Bu çalışmanın temel amacı, yüksek enerjili yaralanmaya bağlı segmental femur cisim kırığı nedeniyle başarılı şekilde tedavi edilen hastaların uzun dönem fiziksel ve mental sağlık skorlarının yaşa uyumlu genel popülasyon normatif değerlerine ulaşıp ulaşmadığını test etmektir. İkincil amaçlar; sonuçların klinik ve cerrahi belirleyicilerini çoklu doğrusal regresyon ile incelemektir.
GEREÇ ve YÖNTEM: Ocak 2006 ile Aralık 2016 arasında segmental femur cisim kırığı nedeniyle tedavi edilen 40 hastanın 29'u (%72,5) çalışmaya alındı. Sağlıkla ilişkili yaşam kalitesi EuroQol beş boyutlu beş seviye anketi (EQ-5D-5L) ve Türkçe Short Form 36 (SF-36) ile değerlendirildi. SF-36 ve EQ-5D-5L sonuçları yaş uyumlu Türk normatif veriler ile karşılaştırıldı. EQ-5D-5L indeksi hem İtalyan hem de Birleşik Krallık (UK) değer setleri ile hesaplandı. İmplant tipine göre alt grup analizleri Kruskal-Wallis testi ile, eşlik eden yaralanma varlığına göre karşılaştırma Mann-Whitney U testi ile yapıldı. Yaş, cinsiyet, takip süresi, eşlik eden yaralanma ve implant tipini bağımsız değişken olarak içeren çoklu doğrusal regresyon modelleri kuruldu.

BULGULAR: Toplam 29 hasta dahil edildi (medyan yaş 36,0 yıl; %86,2 erkek; medyan takip 5 yıl). SF-36 PCS medyan değeri 41,55 (IQR 27,02–51,99) yaşa uyumlu Türk normatifinden anlamlı düşüktü (p<0,001; norm değerinin %73,5'i), MCS medyan 54,65 (IQR 28,86–58,57) ise normatif düzeydeydi (p=0,552). EQ-5D-5L indeksi (medyan 0,950) ve EQ-VAS (medyan 80,0) da normatif değerlerden anlamlı farklılık göstermedi (sırasıyla p=0,181 ve p=0,073). Eşlik eden yaralanması olan hastalarda PCS anlamlı şekilde daha düşüktü (medyan 31,56'a karşı 49,06; p=0,031). Çoklu doğrusal regresyonda PCS modeli anlamlıydı (R²=0,434; F-p=0,035) ve takip süresi bağımsız bir belirleyici 
olarak öne çıktı (β=2,58; p=0,020). EQ-VAS modelinde yaş (β=−0,40; p=0,012) ve takip süresi (β=1,97; p=0,010) bağımsız belirleyicilerdi (R²=0,608; F-p=0,001). EQ-5D-5L indeksi İtalyan değer setiyle 0,950, UK değer setiyle 0,937 olarak hesaplandı; iki değer seti arasında çok 
güçlü korelasyon vardı (Spearman ρ=0,982). İmplant tipine göre yaşam kalitesi skorlarında anlamlı farklılık saptanmadı (tüm p>0,15). Role
physical, bodily pain, social functioning ve role emotional alt boyutlarında belirgin tavan etkisi (>%40) gözlendi.
SONUÇ: Yüksek enerjili segmental femur cisim kırıklarının başarılı cerrahi tedavisi sonrasında uzun dönemde fiziksel sağlık skorları popülasyon normuna ulaşamamakta, buna karşın mental sağlık skorları ve global yaşam kalitesi göstergeleri (MCS ve EQ-5D-5L indeksi) normatif düzeyi yakalamaktadır. Eşlik eden yaralanma varlığı fiziksel sağlığı bağımsız şekilde olumsuz etkileyen bir belirleyicidir; daha uzun takip süresi ise daha iyi fiziksel sağlık ve EQ-VAS skoru ile ilişkilidir. EQ-5D-5L indeksi değer seti seçiminden minimal etkilenmektedir.

Anahtar Kelimeler

• EQ-5D-5L
• femur kırıkları
• SF-36
• segmental femur
• yaşam kalitesi

Destekleyen Kurum

Yok

Etik Beyan

Bu çalışma, Celal Bayar Üniversitesi Kurumsal Etik Kurulu tarafından onaylanmıştır (tarih: 28.03.2018, karar numarası: 20.478.486). Çalışma, Helsinki Bildirgesi'ne uygun olarak yürütülmüştür.

Teşekkür

Yok

Health-Related Quality of Life Assessment After Successful Treatment of Segmental Femoral Fractures

Öz

OBJECTIVE: The primary aim of this study was to test the hypothesis that long-term physical and mental health scores after successful surgical treatment of high-energy segmental femoral shaft fractures reach the level of age-matched general-population norms. Secondary aims were to identify clinical and surgical determinants of these outcomes using multivariable linear regression.
MATERIALS and METHODS: Of 40 patients treated for segmental femoral shaft fractures between January 2006 and December 2016, 29 (72.5%) were included. Health-related quality of life was assessed with the EQ-5D-5L and the Turkish Short Form 36 (SF-36). SF-36 subdomain and component summary scores were compared with age-matched Turkish normative data. The EQ-5D-5L index was calculated using both the Italian and United Kingdom (UK) value sets. Subgroup comparisons by implant type were performed using the Kruskal–Wallis test, and comparisons by associated injury status using the Mann–Whitney U test. Multivariable linear regression models were constructed for PCS, MCS, EQ-5D-5L index and EQ-VAS, with age, sex, follow-up duration, presence of associated injury, and implant type as independent variables. Floor and ceiling effects were quantified for all SF-36 subdomains.
RESULTS: Twenty-nine patients (median age 36.0 years; 86.2% male; median follow-up 5 years) were analysed. The median SF-36 PCS was 41.55 (IQR 27.02–51.99), significantly below age-matched Turkish norms (p<0.001), whereas MCS (median 54.65, IQR 28.86–58.57) was within normal limits (p=0.552). PCS was significantly lower in patients with associated injuries than in those without (median 31.56 vs. 49.06; p=0.031). The multivariable PCS model was statistically significant (R²=0.434; F-p=0.035), with longer follow-up duration as an independent predictor of better PCS (β=2.58; 95% CI 0.45–4.72; p=0.020). The EQ-VAS model demonstrated strong fit (R²=0.608; F-p=0.001), with younger age (β=−0.40; p=0.012) and longer follow-up (β=1.97; p=0.010) as independent predictors. The median EQ-5D-5L index was 0.950 with the Italian value set and 0.937 with the UK value set; the two value sets correlated almost perfectly (Spearman ρ=0.982). Quality of life scores did not differ significantly between implant subgroups (all p>0.15). Pronounced ceiling effects (>40%) were observed in role physical, bodily pain, social functioning and role emotional subdomains.
CONCLUSION: After successful surgical treatment of high-energy segmental femoral shaft fractures, long-term physical health scores fail to reach age-matched population norms, whereas mental health scores and global health-utility estimates (MCS and EQ-5D-5L index) attain normative levels. The presence of associated injuries is an independent negative determinant of physical health, while longer follow-up duration is associated with better physical health and EQ-VAS. EQ-5D-5L index estimates are minimally sensitive to value-set selection.

Anahtar Kelimeler

• EQ-5D-5L
• femoral fractures
• quality of life
• segmental femur
• SF-36

Destekleyen Kurum

None

Etik Beyan

This study was approved by the Institutional Ethics Committee of Celal Bayar University (date: 28.03.2018, decision number: 20.478.486). The study was conducted in accordance with the Declaration of Helsinki.

Teşekkür

None

Kaynakça

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