| Objective:To clarify the clinical epidemiological characteristics of traumatic fracture patients and the occurrence of PTSD in fracture patients,analyze the factors affecting the prognosis of fracture patients,and provide references for the prevention of PTSD in fracture patients and improve the prognosis.Method:In this study,a total of 204 trauma fracture inpatients were recruited from a grade 3A hospital of Guizhou Province,and 204 patients with respiratory diseases(COPD,asthma,community pneumonia,tuberculosis,lung cancer,etc.)were matched 1:1 according to gender,age(±5 years),and ethnicity.In addition,exposure group and control group were divided according to whether they were exposed to traumatic or not.Phase 1: General information survey,the questionnaire included: gender,age,ethnicity,monthly income,educational level,trauma history and living habits.Phase 2: PTSD assessment.PTSD-SS scale was used to conduct PTSD assessment on the research subjects.Phase 3: clinical data collection.The procalcitonin,glucose and lipids metablism,myocardial enzymes,C-reactive protein,myoglobin,High-sensitivity cardiac troponin T and other biochemical indicators were collected on the 1,3,7,14/28 days after admission.Descriptive analyses were used for the basic data of patients,and the Chi-square test was used to analyze the differences of composition ratios,then the t test and the analysis of variance and/or the rank-sum test were used to compare the difference of biochemical indexes(WBC,RBC,ALT,CRP,etc.)between different groups.Kaplan-Meier and Cox’s proportional hazards regression model were used to analyses the influencing factors of LOS.Correlation analysis,factorial analysis and path analysis were used for the prognostic factors of PTSD.P<0.05 was considered statistically significant.Result:(1)Among 204 hospitalized patients with traumatic fractures recruited in this study,the sex ratio was 1.52:1,with the largest propotion of fractures in the 41-60 age.(2)Among all the causes of traumatic fractures,47.06%(96 people)were falls,followed by 22.55% falling from height(46 people),and 22.06% in traffic accidents(45people).Moreover,falls mainly led to minor injuries,while serious injuries were mainly caused by falling from high altitude and traffic accidents,while a variety of reasons all could result in serious injuries.The ISS scores ranged from 4 to 45,with an average score was11.56±8.57 points,of which 75.98%(155 cases)were ?16 points,and the number of injured decreased with the increase of ISS.The NRS score ranged between 1-10 points,with average score was 6.79±2.44,and the number of people increased with the increase in pain.The results of Mantel-Haenszel Chi-square test showed an association between ISS and NRS(P<0.05).(3)The most serious sites of fracture were lower limb fractures.The first three complications were swelling in 39.22%(80 cases),deep vein thrombosis in 22.06%(45cases),and hemopneumothorax in 9.31%(19 cases).The largest proportion of fracture sequelae was pain in 30.39%(62 cases),followed by other system infections in 11.76%(24cases).Most of the patients(81.86%)showed improvement in their recovery at discharge,only 6.86% of the patients were discharged abnormally,and 73.53% were partially self-care.Furthermore,the study found that the average LOS of fracture patients was 18.17±9.76 days.Cox regression analysis found that critical illness during hospitalization(HR=1.70),1operation(HR=2.18)and 2 operations(HR=2.04)were risk factors of LOS.(4)Blood parameters,liver and renal function indexes,CRP,ESR and TG of fracture patients had statistical significance compared with those of patients with respiratory diseases(all P<0.05)at different time after admission.On days 1,3,7 and 14 of admission,the WBC level of fracture patients was higher,while the RBC level and HB level were lower than that of respiratory patients.The ALP levels on the 1st and 14 th days were lower in patients with fractures than those in the respiratory patients(P=0.010 and P=0.004);and the levels of CHE in patients with fractures were lower than respiratory patients on the 7th day after admission.(5)Among fracture patients in this study,30.39% had positive PTSD symptoms(62/204,the total PTSD scores of fracture patients ranged from 24 to 98 points).The degree of injury combined with surgery had an interactive effect on the PTSD scores of fracture patients.Path analysis found that there were five factors that directly affect the PTSD of fracture patients.Among them,coma and ideal physical activity could alleviate PTSD symptoms,while the severity of the injury,the increase in pain,and women with more severe PTSD symptoms,and thus affect the fracture prognosis.PTSD was a positive influence factor on the prognostic indicators(length of stay and cost of stay)of patients with traumatic fracture.Conclusion:Males,41-60 years old and rural areas have larger traumatic fracture proportions,and falls are the main cause.Patients with traumatic fractures have a longer LOS,and on the 1,3,7 and 14 days of admission,the WBC of fracture patients is higher,while the levels of RBC and HB are lower than those of patients with respiratory diseases.The positive detection rate of PTSD symptoms after traumatic fracture is 30.39%.Coma and more ideal physical activity are the protective factors for PTSD,however,the increase in severity of injury and pain,women are more likely to develop PTSD,and PTSD was a positive predictor of prognosis.Therefore,relevant departments should take targeted measures to promote publicity the first aid knowledge of post-fracture safety for the population at high risk.Medical staff and family members should strengthen the care of patients’ physical and mental health to reduce the occurrence of PTSD,which is of great benefit to improve the prognosis of traumatic fracture. |
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