Dangelmajer Sean, Yang Arthur, Githens Michael, Harris Alex H S, Bishop Julius A
Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.
Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
Geriatr Orthop Surg Rehabil. 2017 Sep;8(3):155-160. doi: 10.1177/2151458517720991. Epub 2017 Aug 8.
Recent clinical evidence suggests that total hip arthroplasty (THA) provides improved clinical outcomes as compared to hemiarthroplasty (HA) for displaced femoral neck fractures in elderly individuals. However, THA is still utilized relatively infrequently. Few studies have evaluated the factors affecting utilization and the role socioeconomics plays in THA versus HA.
In the United States, the National Inpatient Sample (NIS) database was used to identify patients treated surgically for femoral neck fracture, between 2009 and 2010. Patients were identified using , codes for closed, transcervical femoral neck fractures and closed fractures at unspecified parts of the femoral neck. All candidate predictors of THA versus HA were entered into a multilevel mixed-effect regression model.
Older patient age, being Asian or Pacific Islander, and having Medicaid payer status were all associated with lower odds of receiving THA. Patients with private insurance including Health Maintenance organization (HMO) had higher odds of THA as did patients with other insurance. Odds of THA were significantly lower among patients in teaching hospitals and higher at hospitals with greater THA volume.
Ethnicity, payer status, hospital size, and institutional THA volume were all associated with the utilization of THA versus HA in the treatment of geriatric femoral neck fractures.
Level III Retrospective Cohort study.
近期临床证据表明，对于老年患者的移位型股骨颈骨折，全髋关节置换术（THA）与半髋关节置换术（HA）相比能提供更好的临床疗效。然而，THA的使用频率仍然相对较低。很少有研究评估影响其使用的因素以及社会经济因素在THA与HA选择中所起的作用。
在美国，利用国家住院样本（NIS）数据库识别2009年至2010年间接受股骨颈骨折手术治疗的患者。通过闭合性经颈股骨颈骨折以及股骨颈未明确部位的闭合性骨折的编码来识别患者。将所有THA与HA的候选预测因素纳入多层次混合效应回归模型。
患者年龄较大、为亚裔或太平洋岛民以及拥有医疗补助支付者身份均与接受THA的较低几率相关。包括健康维护组织（HMO）在内的拥有私人保险的患者接受THA的几率较高，其他保险的患者也是如此。教学医院的患者接受THA的几率显著较低，而THA手术量较大的医院中患者接受THA的几率较高。
种族、支付者身份、医院规模以及机构的THA手术量均与老年股骨颈骨折治疗中THA与HA的使用情况相关。
III级回顾性队列研究。
