Sprague Sheila, Schemitsch Emil H, Swiontkowski Marc, Della Rocca Gregory J, Jeray Kyle J, Liew Susan, Slobogean Gerard P, Bzovsky Sofia, Heels-Ansdell Diane, Zhou Qi, Bhandari Mohit
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
J Orthop Trauma. 2018 May;32(5):223-230. doi: 10.1097/BOT.0000000000001162.
Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device.
We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation.
Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02-1.39; P = 0.027), displaced fracture (HR 2.16, 95% CI 1.44-3.23; P < 0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59-4.55; P < 0.001), and smokers treated with cancellous screws versus smokers treated with a sliding hip screw (HR 2.94, 95% CI 1.35-6.25; P = 0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal.
Results of this study may inform future research by identifying high-risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care (HR 1.39, 95% CI 1.05-1.85; P = 0.020).
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
股骨颈骨折内固定治疗后翻修手术率较高。利用“使用替代植入物固定治疗髋部骨折（FAITH）”试验的数据，该试验评估了股骨颈骨折患者的内固定方法，我们调查了基线因素和手术因素与术后24个月内为促进愈合、缓解疼痛、治疗感染或改善功能而进行翻修手术需求之间的关联。此外，我们还调查了与以下情况相关的因素：（1）取出内固定装置；（2）从松质骨螺钉（CS）或滑动髋螺钉（SHS）更换为全髋关节置换术、半髋关节置换术或其他内固定装置。
我们预先确定了15个可能与翻修手术相关的潜在因素、7个与取出内固定装置相关的因素以及14个与植入物更换相关的因素。我们在调查中使用了多变量Cox比例风险分析。
与翻修手术风险增加相关的因素包括：女性（风险比[HR]1.79，95%置信区间[CI]1.25 - 2.50；P = 0.001）、较高的体重指数（每增加5个单位）（HR 1.19，95% CI 1.02 - 1.39；P = 0.027）、移位骨折（HR 2.16，95% CI 1.44 - 3.23；P < 0.001）、植入物放置质量不合格（HR 2.70，95% CI 1.59 - 4.55；P < 0.001），以及接受松质骨螺钉治疗的吸烟者与接受滑动髋螺钉治疗的吸烟者相比（HR 2.94，95% CI 1.35 - 6.25；P = 0.006）。此外，年龄每降低10岁，参与者取出内固定装置的平均风险增加39%。
本研究结果可能为未来研究提供参考，通过识别可能更适合接受关节置换术治疗且可能从辅助护理中获益的高危患者（HR 1.39，95% CI 1.05 - 1.85；P = 0.020）。
预后II级。有关证据水平的完整描述，请参阅作者须知。
