Zentrum für Unfallchirurgie und orthopädische Chirurgie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany.
Orthopaedicum Wiesbaden, Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Friedrichstrasse 29, 65185, Wiesbaden, Germany.
Arch Orthop Trauma Surg. 2019 Dec;139(12):1713-1721. doi: 10.1007/s00402-019-03252-1. Epub 2019 Aug 2.
Proximal humeral fractures (PHF) are among the most common adult fractures. However, valid epidemiologic population-based data, including differentiation of treatment modalities, are lacking.
Using the ICD codes and associated OPS codes for PHF, a retrospective analysis of 2007-2016 Federal Statistical Office of Germany data was performed. Data were evaluated for total incidence of PHF as well as total use, annual utilization rates, age, and sex distributions of all associated surgical procedures. Simple linear regressions were performed to evaluate trends in treatment modalities.
There were 642,556 cases of PHF. During the study period, incidence changed substantially from 65.2 to 74.2 per 100,000 inhabitants with a significant rise in elderly (> 70 years) patients (P < 0.001). The number of surgical procedures increased by 39%, with locking plate fixation being the most common procedure (48.3%), followed by intramedullary nailing (IMN) (20.0%), hemiarthroplasty (HA) (7.5%), K-wire fixation (6.4%), and reverse shoulder arthroplasty (RSA) (5.6%). The utilization rate increased for locking plates, K-wires, and RSA and decreased for HA and IMN. Particularly, the utilization of RSA exhibited a > eightfold increase. Significant linear correlation of procedure and time were found for all surgical treatments.
During this period, the number of inpatient PHFs, especially in the elderly, increased. Although locking plate fixation remained the most common treatment method, RSA had the greatest proportional increase over time, supporting its growing popularity in the light of the current scientific evidence. This incline was offset by a corresponding decrease in HA and IMN, which may be related to a growing knowledge of their application limitations.
Descriptive epidemiology study, large database analysis.
肱骨近端骨折（PHF）是最常见的成人骨折之一。然而，缺乏有效的基于人群的流行病学数据，包括治疗方式的区分。
使用德国联邦统计局的 ICD 编码和相关 OPS 编码，对 2007 年至 2016 年的相关数据进行回顾性分析。评估了 PHF 的总发生率以及所有相关手术的总使用率、年利用率、年龄和性别分布。采用简单线性回归分析评估治疗方式的变化趋势。
共有 642,556 例 PHF。在研究期间，发病率从每 100,000 名居民 65.2 例显著增加到 74.2 例，且 70 岁以上老年患者的发病率显著增加（P<0.001）。手术数量增加了 39%，其中锁定钢板固定是最常见的手术方式（48.3%），其次是髓内钉（IMN）（20.0%）、人工半髋关节置换术（HA）（7.5%）、克氏针固定（K 线）（6.4%）和反式肩关节置换术（RSA）（5.6%）。锁定钢板、K 线和 RSA 的使用率增加，而 HA 和 IMN 的使用率降低。特别是 RSA 的使用率增加了 8 倍以上。所有手术治疗方法的手术和时间之间都存在显著的线性相关性。
在这段时间内，住院 PHF 的数量，尤其是老年人的数量有所增加。尽管锁定钢板固定仍然是最常见的治疗方法，但 RSA 的比例随着时间的推移呈指数级增长，这支持了在当前科学证据的基础上，其日益普及。HA 和 IMN 的应用相应减少，这可能与对其应用局限性认识的提高有关。
描述性流行病学研究，大型数据库分析。
