Neuman Mark D, Donegan Derek J, Mehta Samir
Assistant Professor, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia.
Am J Orthop (Belle Mead NJ). 2013 Jul;42(7):E42-7.
Although functional outcomes of hip joint reconstruction may be superior to those of internal fixation, differences in mortality between the 2 procedures are poorly defined. We conducted a retrospective study of patients 50 years and older with femoral neck fracture treated with joint reconstruction or internal fixation, performing adjusted logistic regressions to compare the odds of inpatient and 30-day mortality among patients according to surgery type. Of 12,867 patients with femoral neck fracture, 9001 had joint reconstruction and 3866 had internal fixation. After adjustment for patient factors alone, the odds of inpatient mortality were higher with reconstruction (OR, 1.62; 95% CI, 1.18-2.23; P=.003); however, the difference in the odds of 30-day mortality did not achieve statistical significance (OR, 1.18; 95% CI, 1.00-1.41; P=.053). Controlling for patient and hospital factors, we found higher odds of both inpatient mortality (OR, 1.65; 95% CI, 1.19-2.28; P=.003) and 30-day mortality (OR, 1.22; 95% CI, 1.02-1.46; P=.026) with reconstruction. Joint reconstruction is associated with a 60% increase in the odds of inpatient mortality after femoral neck fracture.
尽管髋关节重建的功能结果可能优于内固定，但这两种手术方式在死亡率上的差异尚不明确。我们对50岁及以上接受关节重建或内固定治疗的股骨颈骨折患者进行了一项回顾性研究，通过调整后的逻辑回归分析，根据手术类型比较患者住院期间及30天死亡率的比值。在12,867例股骨颈骨折患者中，9001例行关节重建，3866例行内固定。仅对患者因素进行调整后，重建组患者住院死亡率的比值较高（比值比[OR]，1.62；95%置信区间[CI]，1.18 - 2.23；P = 0.003）；然而，30天死亡率的比值差异未达到统计学意义（OR，1.18；95% CI，1.00 - 1.41；P = 0.053）。在控制患者和医院因素后，我们发现重建组患者住院死亡率（OR，1.65；95% CI，1.19 - 2.28；P = 0.003）和30天死亡率（OR，1.22；95% CI，1.02 - 1.46；P = 0.026）的比值均较高。股骨颈骨折后，关节重建与住院死亡率的比值增加60%相关。
