Werner Brian C, Fashandi Ahmad H, Gwathmey F Winston, Yarboro Seth R
University of Virginia Health System, Charlottesville, Virginia - USA.
Hip Int. 2015 May-Jun;25(3):270-6. doi: 10.5301/hipint.5000216. Epub 2015 Apr 15.
In the last 2 decades, surgical treatment of intertrochanteric (IT) femur fractures has shown a continuing trend towards the increased use of intramedullary nails (IMN) and decreased use of sliding hip screws (SHS). Recent trends in the United States regarding the use of these implants, including charges and reimbursement, have not been investigated.
A national database of Medicare patients (PearlDiver, Inc.) was queried using Current Procedural Terminology (CPT) codes for patients with surgical dates from 2005-2011.
A total of 34,759 SHS or IMN procedures for intertrochanteric femur fractures were identified from 2005-2011. There was a significant increase in the percentage of IMN compared to SHS, from 46.9% IMN in 2005 to 79.1% in 2011. The average charges for IMN and SHS increased. Statistically higher rates of PE (p<0.001), DVT (p<0.001), MI (p<0.001), respiratory failure (p<0.001), UTI (p<0.001), pneumonia (p<0.001), CVA (p<0.001) and blood transfusion (p<0.001) were noted in the IMN group. The SHS group had higher 1 year (4.3% vs 3.8%, p = 0.012) and 2 year (5.8% vs 5.0%, p = 0.002) mortality rates.
The previously recognised trend of increasing use of IMN for IT femur fractures has continued. The overall incidence of operative IT femur fractures is not increasing at this time. The cost of IMN remains higher than SHS.
在过去20年中，股骨粗隆间骨折的手术治疗呈现出髓内钉（IMN）使用增加、滑动髋螺钉（SHS）使用减少的持续趋势。美国关于这些植入物使用的近期趋势，包括费用和报销情况，尚未得到研究。
使用现行程序术语（CPT）编码查询医疗保险患者的全国数据库（PearlDiver公司），以获取2005年至2011年手术日期的患者信息。
2005年至2011年共识别出34759例股骨粗隆间骨折的SHS或IMN手术。与SHS相比，IMN的百分比显著增加，从2005年的46.9%增加到2011年的79.1%。IMN和SHS的平均费用均有所增加。IMN组的肺栓塞（p<0.001）、深静脉血栓形成（p<0.001）、心肌梗死（p<0.001）、呼吸衰竭（p<0.001）、尿路感染（p<0.001）、肺炎（p<0.001）、脑血管意外（p<0.001）和输血（p<0.001）发生率在统计学上更高。SHS组的1年（4.3%对3.8%，p = 0.012）和2年（5.8%对5.0%，p = 0.002）死亡率更高。
之前公认的股骨粗隆间骨折使用IMN增加的趋势仍在继续。目前股骨粗隆间骨折手术的总体发生率并未增加。IMN的成本仍然高于SHS。
