Dixit Anant, Cautela Frank S, Cooper Colin S, Beyer George A, Messina James C, Mait Jeffrey E, Shah Neil V, Diebo Bassel G, Paulino Carl B, Urban William P
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
J Orthop Traumatol. 2018 Aug 22;19(1):12. doi: 10.1186/s10195-018-0503-1.
Limited data exists in analyzing open reduction and internal fixation (ORIF) and arthroplasty in the management of open proximal humerus fractures. We analyzed differences in hospital course between these procedures, patient demographics, complication rate, length of stay, hospital charges, and mortality rate.
This is a retrospective review of the Nationwide Inpatient Sample database. ICD-9 codes identified patients hospitalized for open proximal humerus fractures from 1998 to 2013 who underwent ORIF or shoulder arthroplasty (hemi-, total, or reverse). Demographics and in-hospital complications were compared. Logistic regression controlling for age, gender, and Deyo index tested the impact of ORIF vs ARTH on any complications.
Seven hundred thirty patients were included (ORIF, n = 662 vs ARTH, n = 68). ORIF patients were younger (p < 0.001), more likely to be males (p < 0.001), and had a lower Deyo score (p = 0.012). Both groups had comparable complication rates (21.4% vs 18.0%, p = 0.535), lengths of stay (7.86 days vs 7.44 days, p = 0.833), hospital charges ($76,998 vs $64,133, p = 0.360), and mortality rates (0.2% vs 0%, p = 0.761). Type of surgery was not a predictor of any complications (OR = 0.67 [95% CI 0.33-1.35], p = 0.266), extended length of stay (OR = 1.01 [95% CI 0.58-1.78], p = 0.967), or high hospital charges (OR = 1.39 [95% CI 0.68-2.86], p = 0.366).
We revealed no differences in hospital course between ORIF and arthroplasty for management of open proximal humerus fractures. Although differences in demographics existed, no differences in complication rates, length of stay, hospital charges and mortality rates were noted. Future studies can evaluate the long-term outcomes of these procedures.
Level III.
在分析切开复位内固定术（ORIF）和关节成形术治疗开放性肱骨近端骨折方面，现有数据有限。我们分析了这些手术在住院过程、患者人口统计学特征、并发症发生率、住院时间、住院费用和死亡率方面的差异。
这是一项对全国住院患者样本数据库的回顾性研究。国际疾病分类第九版（ICD - 9）编码确定了1998年至2013年因开放性肱骨近端骨折住院并接受ORIF或肩关节成形术（半肩关节成形术、全肩关节成形术或反肩关节成形术）的患者。比较了人口统计学特征和院内并发症情况。采用逻辑回归分析，控制年龄、性别和迪约指数，以测试ORIF与关节成形术对任何并发症的影响。
共纳入730例患者（ORIF组，n = 662例；关节成形术组，n = 68例）。ORIF组患者更年轻（p < 0.001），男性比例更高（p < 0.001），迪约评分更低（p = 0.012）。两组的并发症发生率（21.4%对18.0%，p = 0.535）、住院时间（7.86天对7.44天，p = 0.833）、住院费用（76,998美元对64,133美元，p = 0.360）和死亡率（0.2%对0%，p = 0.761）相当。手术类型不是任何并发症（比值比[OR] = 0.67[95%置信区间0.33 - 1.35]，p = 0.266）、延长住院时间（OR = 1.01[95%置信区间0.58 - 1.78]，p = 0.967）或高额住院费用（OR = 1.39[95%置信区间0.68 - 2.86]，p = 0.366）的预测因素。
我们发现ORIF和关节成形术在治疗开放性肱骨近端骨折的住院过程中没有差异。尽管在人口统计学特征上存在差异，但在并发症发生率、住院时间、住院费用和死亡率方面未发现差异。未来的研究可以评估这些手术的长期疗效。
三级。
