Rajaee Sean S, Yalamanchili Dheeraj, Noori Naudereh, Debbi Eytan, Mirocha James, Lin Carol A, Moon Charles N
Orthopedics. 2017 Nov 1;40(6):e982-e989. doi: 10.3928/01477447-20170925-01. Epub 2017 Oct 3.
This study described surgical treatment patterns for proximal humerus fractures among elderly patients, focusing on reverse total shoulder arthroplasty (TSA), and evaluated how the type of fixation affects inpatient factors (cost, length of stay), transfusion rates, and patient disposition (home vs skilled nursing facility). With Nationwide Inpatient Sample data from 2011 to 2013, the authors identified patients 65 years and older who had proximal humerus fractures and divided them into 3 groups: (1) open reduction and internal fixation (ORIF); (2) hemiarthroplasty; and (3) reverse TSA. From 2011 to 2013, 38,729 surgically treated proximal humerus fractures were identified. The rate of reverse TSA increased 1.8-fold during this time, from 13% of operative cases in 2011 to 24% of operative cases in 2013 (P<.001). At the same time, the rates of hemiarthroplasty and ORIF decreased (hemiarthroplasty, from 28% to 21%; ORIF, from 59% to 55%). Although reverse TSA accounted for 32.2% of arthroplasty procedures for proximal humerus fractures in 2011, this value was 53.3% in 2013 (P<.001). In 2013, mean total hospital cost for reverse TSA was $24,154, which was significantly higher than that for ORIF ($16,269) or hemiarthroplasty ($19,175) (P<.001). In a multivariable model, patients undergoing reverse TSA were less likely than those undergoing hemiarthroplasty to be discharged to a skilled nursing facility (odds ratio, 0.75; P=.027). The national rate of reverse TSA nearly doubled from 2011 to 2013. As of 2013, reverse TSA replaced hemiarthroplasty as the most commonly performed arthroplasty procedure for proximal humerus fractures for patients 65 years and older. Patients undergoing reverse TSA were more likely than those undergoing hemiarthroplasty to be discharged home. [Orthopedics. 2017; 40(6):e982-e989.].
本研究描述了老年患者肱骨近端骨折的手术治疗模式，重点关注反式全肩关节置换术（TSA），并评估了固定类型如何影响住院因素（费用、住院时间）、输血率以及患者出院去向（回家与入住专业护理机构）。利用2011年至2013年的全国住院患者样本数据，作者确定了65岁及以上的肱骨近端骨折患者，并将他们分为3组：（1）切开复位内固定术（ORIF）；（2）半关节置换术；（3）反式TSA。2011年至2013年期间，共确定了38729例接受手术治疗的肱骨近端骨折患者。在此期间，反式TSA的比例增加了1.8倍，从2011年手术病例的13%增至2013年手术病例的24%（P<0.001）。与此同时，半关节置换术和ORIF的比例下降（半关节置换术，从28%降至21%；ORIF，从59%降至55%）。尽管2011年反式TSA占肱骨近端骨折关节置换手术的32.2%，但2013年该值为53.3%（P<0.001）。2013年，反式TSA的平均住院总费用为24154美元，显著高于ORIF（16269美元）或半关节置换术（19175美元）（P<0.001）。在多变量模型中，接受反式TSA的患者比接受半关节置换术的患者出院后入住专业护理机构的可能性更小（优势比，0.75；P=0.027）。2011年至2013年，全国反式TSA的比例几乎翻了一番。截至2013年，反式TSA取代半关节置换术，成为65岁及以上患者肱骨近端骨折最常用的关节置换手术。接受反式TSA的患者比接受半关节置换术的患者更有可能出院回家。[《骨科学》。2017；40(6):e982 - e989。]
