髓内钉与钢板治疗肱骨干骨折的疗效比较：一项 Medicare 队列研究。
Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study.
机构信息
National Institutes of Health, Bethesda, MD 20892-1150, USA.
出版信息
J Orthop Trauma. 2013 Feb;27(2):68-72. doi: 10.1097/BOT.0b013e31824a3e66.
OBJECTIVES
This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality.
DESIGN/SETTING: Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed.
PATIENTS/INTERVENTION: Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures.
MAIN OUTCOME MEASUREMENT
The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards.
RESULTS
We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality.
CONCLUSIONS
Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality.
LEVEL OF EVIDENCE
: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
目的
本研究旨在：（1）确定医疗保险非癌症人群中肱骨干骨折的发生率；（2）评估使用钢板和螺钉装置及髓内钉固定肱骨干的技术的利用趋势；（3）比较手术时间的差异；（4）通过二次手术发生率和 1 年死亡率评估个体的治疗结果。
设计/设置：回顾性比较队列分析。我们分析了从 1993 年至 2007 年的医疗保险 B 部分索赔样本中随机抽取的 5%的无癌症患者样本。
患者/干预措施：我们的患者队列是根据肱骨干骨折的诊断和操作代码生成的。
主要观察指标
评估所有年份肱骨干骨折的发生率和手术固定趋势。通过麻醉的当前操作术语代码评估手术时间。通过当前操作术语代码评估结果和并发症。通过比例风险比较发生并发症和 1 年死亡率的个体比例。
结果
在 15 年期间，我们共发现了 1385 例肱骨干骨折索赔，调整后每 100000 名受益人的骨折发生率在 12.0 至 23.4 之间。我们发现了 511 例肱骨干骨折接受手术治疗的患者，其中 451 例有完整的 1 年随访数据。大多数年份，髓内钉固定的比例都高于钢板固定，麻醉时间平均缩短了 27.1 分钟（P < 0.0001）。两组之间在二次手术发生率和 1 年死亡率方面的并发症发生率没有显著差异。
结论
在 Medicare 受益人群中，髓内钉是治疗肱骨干骨折的主要手术方法。髓内钉的平均手术时间更短。两种手术技术在二次手术风险和 1 年死亡率方面没有显著差异。
证据水平
预后 II 级。欲了解完整的证据级别说明，请参见作者须知。
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