胫骨骨折手术治疗中筋膜切开术的地域差异。
Geographic variation in fasciotomy during operative management of tibia fractures.
作者信息
Anders Mark, Mutty Christopher, Cornwall Allison
机构信息
State University of New York at Buffalo, Dept. of Orthopaedics, Erie County Medical Center, Buffalo, NY 14215, United States.
出版信息
J Orthop. 2015 Jun 9;13(3):225-9. doi: 10.1016/j.jor.2015.05.002. eCollection 2016 Sep.
BACKGROUND
Diagnosis and treatment of acute or impending compartment syndrome (ACS) remains a clinical challenge. ACS is a clinical diagnosis, and may be associated with variation in its definition, as well as individual threshold for fasciotomy. We examined regional and state variation in rates of lower extremity fasciotomy associated with operatively managed tibia fractures.
METHODS
A total of 313,344 surgically treated tibia fractures were identified via Current Procedural Terminology (CPT) codes using PearlDiver, a private-payer medical record database. Data from the PearlDiver database was compared to the National Trauma Data Bank trauma registry data to corroborate calculated fasciotomy rates.
RESULTS
The aggregate United States fasciotomy rate derived from PearlDiver was 2.57%. State fasciotomy rates were wide-ranging (0.03%-11.86%) with an average state rate of 2.22% (n = 47, SD = 2.27).
CONCLUSIONS
There was significant state-to-state variation in the use of fasciotomy during operative management of tibial fractures. Various factors may have contributed to the observed difference of state fasciotomy rates.
LEVEL OF EVIDENCE
This is a Level III epidemiological study retrospectively comparing geographic rates of fasciotomy during operative management of tibia fractures.
背景
急性或即将发生的骨筋膜室综合征（ACS）的诊断和治疗仍然是一项临床挑战。ACS是一种临床诊断，其定义可能存在差异，并且筋膜切开术的个体阈值也有所不同。我们研究了与手术治疗的胫骨骨折相关的下肢筋膜切开术发生率的地区和州差异。
方法
使用私人医保病历数据库PearlDiver，通过当前操作术语（CPT）代码识别出总共313,344例接受手术治疗的胫骨骨折。将PearlDiver数据库中的数据与国家创伤数据库创伤登记数据进行比较，以证实计算出的筋膜切开术发生率。
结果
PearlDiver得出的美国总体筋膜切开术发生率为2.57%。各州的筋膜切开术发生率差异很大（0.03% - 11.86%），平均州发生率为2.22%（n = 47，标准差 = 2.27）。
结论
在胫骨骨折手术治疗期间，筋膜切开术的使用存在显著的州际差异。多种因素可能导致了观察到的各州筋膜切开术发生率的差异。
证据水平
这是一项III级流行病学研究，回顾性比较胫骨骨折手术治疗期间筋膜切开术的地理发生率。
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