Sabesan Vani J, Lombardo Daniel, Petersen-Fitts Graysen, Weisman Martin, Ramthun Kyle, Whaley James
Department of Orthopaedic Surgery, Wayne State University/Oakwood, 10000 Telegraph Road, Taylor, MI, 48180, USA.
Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI, 48201, USA.
Aging Clin Exp Res. 2017 Dec;29(6):1277-1283. doi: 10.1007/s40520-016-0695-2. Epub 2017 Jan 25.
The treatment of proximal humerus fractures (PHF) is largely surgeon dependent with no clear guidelines for selecting the optimal method of treatment.
The aim of this study was to evaluate trends and variations in treatment methods of PHF in the United States from 2004 to 2012 and to determine the regional differences in treatment.
The National Inpatient Sample was used to identify all patient discharges with diagnosis codes for PHF and the data were classified based on ICD-9 procedure codes. Patient and hospital demographics were also analyzed. Simple linear regression analyses were performed for each treatment modality to evaluate current treatment trends and to extrapolate the future trends of PHF treatment over the next 20 years.
A national estimate of 550,116 PHF discharges was identified over the time period. Significant correlations between change over time and treatment modality were found for reverse shoulder arthroplasty (RSA) (r = 0.903, p < 0.001), open reduction internal fixation (r = 0.876, p = 0.002), and closed reduction internal fixation (r = -0.922, p < 0.001). The RSA regression model showed that by the year 2032, PHF treated with RSA will increase 100% from 2012.
There were significant changes in treatment modalities for PHF from 2004 to 2012; The projected number of RSA used to treat PHF will be about 9115 in 2032, compared to 340 in 2004.
Overall, there was a growth in proximal humerus fractures treated in an inpatient setting in the United States. RSA had the greatest proportional increase over time, but only accounted for less than 2% of total interventions.
肱骨近端骨折（PHF）的治疗很大程度上取决于外科医生，目前尚无明确的指南来选择最佳治疗方法。
本研究旨在评估2004年至2012年美国PHF治疗方法的趋势和差异，并确定治疗的地区差异。
使用国家住院患者样本识别所有诊断编码为PHF的患者出院病例，并根据ICD-9手术编码对数据进行分类。还分析了患者和医院的人口统计学数据。对每种治疗方式进行简单线性回归分析，以评估当前的治疗趋势，并推断未来20年PHF治疗的趋势。
在此期间，全国范围内共识别出550116例PHF出院病例。发现随着时间的变化与治疗方式之间存在显著相关性，对于反肩关节置换术（RSA）（r = 0.903，p < 0.001）、切开复位内固定术（r = 0.876，p = 0.002）和闭合复位内固定术（r = -0.922，p < 0.001）。RSA回归模型显示，到2032年，接受RSA治疗的PHF将比2012年增加100%。
2004年至2012年期间，PHF的治疗方式发生了显著变化；预计2032年用于治疗PHF的RSA数量将约为9115例，而2004年为340例。
总体而言，美国住院治疗的肱骨近端骨折有所增加。随着时间的推移，RSA的比例增长最大，但仅占总干预措施的不到2%。
