Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, United States; Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, 02215, United States.
Harvard Medical School, Boston, MA, 02115, United States; Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, 02215, United States.
Injury. 2019 Aug;50(8):1448-1451. doi: 10.1016/j.injury.2019.07.005. Epub 2019 Jul 12.
Patients treated with hip hemiarthroplasty for low energy femoral neck fractures routinely undergo hip radiographs at each postoperative clinic visit regardless of history and physical findings. No studies to date have evaluated the effectiveness of this accepted practice. The goal of this study was to identify the postoperative utility of both history and physical (H/P) and hip radiographs in the treatment course of patients treated with hip hemiarthroplasty for low energy femoral neck fractures.
A retrospective chart review was performed on consecutive patients treated with hip hemiarthroplasty for low energy femoral neck fractures. An abnormal H/P and hip radiographs as well as a change in treatment course were recorded at each clinic or emergency department visit.
Five hundred and eighty-three patients met inclusion criteria, consisting of 1177 clinic and 50 emergency department (ED) visits. An abnormal radiograph in the presence of a normal H/P did not lead to a change in treatment course. An abnormal H/P alone changed treatment course in 28 (3%) clinic visits and 18 (36%) ED visits. An abnormal H/P and the presence of an abnormal hip radiograph changed the treatment course in 23 (2%) clinic visits and 18 (36%) ED visits. In only one case - 0.3% of abnormal radiographs or 0.08% of 1177 clinic visits - did an abnormal hip radiograph change treatment course in the setting of an abnormal H/P within 6 months from surgery. The average cost of a series of hip and pelvis radiographs was $242.
Abnormal radiographs do not change treatment course in the presence of a normal H/P. Hip radiographs obtained in clinic within 6 months of surgery rarely lead to a change in treatment course and thereby are a source of excess cost and radiation exposure to the patient.
接受髋关节半髋关节置换术治疗低能量股骨颈骨折的患者，无论病史和体格检查结果如何，每次术后门诊就诊都常规进行髋关节 X 光检查。迄今为止，尚无研究评估这种公认做法的有效性。本研究的目的是确定病史和体格检查（H/P）以及髋关节 X 光检查在接受髋关节半髋关节置换术治疗低能量股骨颈骨折患者治疗过程中的术后作用。
对连续接受髋关节半髋关节置换术治疗低能量股骨颈骨折的患者进行回顾性图表审查。在每次门诊或急诊科就诊时，记录异常 H/P 和髋关节 X 光检查以及治疗过程的变化。
符合纳入标准的 583 名患者共进行了 1177 次门诊和 50 次急诊科（ED）就诊。正常 H/P 下的异常 X 光片并未导致治疗过程发生变化。单独的异常 H/P 在 28 次（3%）门诊就诊和 18 次（36%）ED 就诊中改变了治疗过程。异常 H/P 和异常髋关节 X 光同时改变了 23 次（2%）门诊就诊和 18 次（36%）ED 就诊的治疗过程。仅在一种情况下 - 异常 X 光片的 0.3%或 1177 次门诊就诊中的 0.08% - 在手术后 6 个月内，异常髋关节 X 光片在异常 H/P 的情况下改变了治疗过程。一组髋关节和骨盆 X 光片的平均成本为 242 美元。
在正常 H/P 的情况下，异常 X 光片不会改变治疗过程。术后 6 个月内获得的髋关节 X 光片很少导致治疗过程发生变化，因此是导致患者过度成本和辐射暴露的原因。
