Müller Franz, Galler Michael, Kottmann Tanja, Zellner Michael, Bäuml Christian, Füchtmeier Bernd
Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
Medizinische Statistik, Beverstraße 64, 59077, Hamm, Deutschland.
Unfallchirurg. 2018 Jul;121(7):550-559. doi: 10.1007/s00113-017-0386-2.
Due to demographic change, more proximal femoral fractures can be expected in the future. However, accurate growth rates as well as follow-up research extending more than 1 year postsurgery are still lacking.
First, we defined inclusion and exclusion criteria for the retrospective cohort study. Based on these, we collected all surgical interventions conducted between 1 January 2006 and 31 December 2015. For a total of 2000 consecutive procedures, we retrieved and analysed a total of 12 variables influencing mortality. Data were retrieved from the prospectively established database; all patients still alive were contacted by phone, and missing data were collected. The endpoint of the study was consistently set for all patients at 2 years postsurgery.
The follow-up rate was 100%. Growth rate increased by 74.1% over a period of 10 years. Mean age of the total population was 79.4 years, and women were predominantly affected (71.7%). Surgical treatment was based on osteosynthesis procedures (57%) using DHS, PFN, or screws, as well as on arthroplasty (43%) performing total hip arthroplasty or implanting large-head prostheses. The revision rate was 14.5%, and mortality 2 years postsurgery was 32.4%. Through a multivariate analysis (Cox regression), the following seven influence factors showed statistically significant impact on mortality: age >82 years, male gender, CRP >10 mg/dl, haemoglobin <12 g/dl, ASA 3 or 4, dementia, and postoperative infection-but not timing of surgery.
The growth rate of proximal femoral fractures progressed more rapidly than expected. Through a multivariate analysis, a total of six intrinsic variables were verified, which influenced the mortality. The prevention of infection-as the only additional extrinsic factor in this study-represents a more important role than early surgical treatment.
由于人口结构变化，预计未来近端股骨骨折的病例会增多。然而，目前仍缺乏准确的增长率数据以及术后1年以上的随访研究。
首先，我们为这项回顾性队列研究定义了纳入和排除标准。在此基础上，我们收集了2006年1月1日至2015年12月31日期间进行的所有手术干预措施。对于总共2000例连续手术病例，我们检索并分析了总共12个影响死亡率的变量。数据从前瞻性建立的数据库中获取；通过电话联系所有仍在世的患者，并收集缺失数据。所有患者的研究终点均统一设定为术后2年。
随访率为100%。在10年期间，增长率提高了74.1%。总体人群的平均年龄为79.4岁，女性受影响更为显著（71.7%）。手术治疗基于使用动力髋螺钉（DHS）、股骨近端髓内钉（PFN）或螺钉的骨固定术（57%），以及进行全髋关节置换术或植入大头假体的关节成形术（43%）。翻修率为14.5%，术后2年的死亡率为32.4%。通过多变量分析（Cox回归），以下七个影响因素对死亡率具有统计学上的显著影响：年龄>82岁、男性、C反应蛋白（CRP）>10mg/dl、血红蛋白<12g/dl、美国麻醉医师协会（ASA）分级为3或4级、痴呆症以及术后感染，但手术时机对死亡率无影响。
近端股骨骨折的增长率比预期进展得更快。通过多变量分析，总共验证了六个内在变量，它们影响死亡率。在本研究中，作为唯一额外的外在因素，预防感染比早期手术治疗更为重要。
