From the Department of Orthopaedic Surgery, University of California San Francisco Fresno Center for Medical Education and Research, Fresno, CA.
J Am Acad Orthop Surg. 2019 Jul 15;27(14):e664-e668. doi: 10.5435/JAAOS-D-17-00901.
The purpose of this study was to evaluate the efficacy of routine pathologic examination (PE) of femoral head (FH) specimens after arthroplasty for acute femoral neck fractures and to determine the cost.
This was a retrospective chart review of 850 acute femoral neck fractures treated with hemiarthroplasty or total hip arthroplasty These were evaluated to determine whether the FH was sent for PE, the resultant findings, alterations in medical treatment, and cost.
A total of 466 FH specimens (54.8%) were sent to pathology. Four (0.9%) were positive for a neoplastic process. All four had a known history of cancer, antecedent hip pain, or an inappropriate injury mechanism. None of the findings resulted in an alteration in medical treatment. The average cost of PE was $195 USD.
The routine PE of FH specimens after arthroplasty for femoral neck fractures is not warranted and uneconomic. Sending the FH for PE, only when clinically indicated, rather than routine, will result in notable savings for the healthcare system.
Level IV.
本研究旨在评估髋关节置换术后股骨颈骨折患者常规行股骨头（FH）病理检查的疗效，并确定其成本。
这是对 850 例接受半髋关节置换术或全髋关节置换术治疗的急性股骨颈骨折患者的回顾性图表分析，以确定 FH 是否送检行病理检查，检查结果，治疗方案的改变以及成本。
共送检 466 例 FH 标本（54.8%）。其中 4 例（0.9%）为阳性，提示存在肿瘤性病变。这 4 例均有明确的癌症病史、髋关节疼痛史或不当的受伤机制。这些检查结果均未导致治疗方案的改变。FH 病理检查的平均费用为 195 美元。
髋关节置换术后常规行股骨颈骨折患者的 FH 病理检查既无必要，也不经济。仅在临床需要时送检 FH 进行病理检查，而不是常规送检，将为医疗系统节省大量费用。
IV 级。
