Warren Jared A, Sundaram Kavin, Hampton Robert, McLaughlin John, Patterson Brendan, Higuera Carlos A, Piuzzi Nicolas S
Department of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Eur J Orthop Surg Traumatol. 2020 Feb;30(2):243-250. doi: 10.1007/s00590-019-02543-y. Epub 2019 Sep 5.
Hip fractures are associated with poor mortality and morbidity outcomes. Controversy exists over what the preferred treatment is between sliding hips screws (SHSs) and cephalomedullary nails (CMNs) for stable intertrochanteric (IT) and basicervical (BC) hip fractures. The purpose of this study was to compare early postoperative outcomes and complications in patients treated with SHS to those treated with CMN in IT and BC hip fractures.
We used the National Surgical Quality Improvement Program database to identify IT and BC hip fractures, excluding subtrochanteric hip fractures treated with a SHS and CMN for 2008 to 2016. After propensity score matching, there were 8505 patients in the SHS cohort and 8505 in the CMN cohort. Propensity score-adjusted multivariate regression models assed SHS as an independent risk factor for the following 30-day outcomes: mortality, postoperative major and minor complications, discharge disposition, readmission and reoperation, length of hospital stay (LOS), and operative time.
No difference in mortality was encountered between SHS and CMN (p = 0.440). Compared to CMN, the SHS cohort had an 11.6% decreased likelihood of a minor complication (p < 0.001); however, no difference was found between CMN and SHS for major complications (p = 0.117). SHS patients were less likely to have transfusion (p < 0.001), DVT (p = 0.007), and MI (0.024). SHS patients were 12.5% more likely to go home (p = 0.002). No association was discovered between being treated with a SHS and reoperation (p = 0.449) and readmission (p = 0.588). SHS patients had almost a quarter of a day longer LOS (p = 0.041). Patients treated with SHS had a statistically significant (p < 0.001), but clinically irrelevant 2-min longer procedure.
III.
髋部骨折与不良的死亡率和发病率结果相关。对于稳定型转子间（IT）和基底部（BC）髋部骨折，滑动髋螺钉（SHS）和髓内钉（CMN）哪种是首选治疗方法存在争议。本研究的目的是比较IT和BC髋部骨折患者接受SHS治疗与接受CMN治疗的术后早期结果和并发症。
我们使用国家外科质量改进计划数据库来识别2008年至2016年接受SHS和CMN治疗的IT和BC髋部骨折患者，排除转子下髋部骨折。经过倾向评分匹配后，SHS队列中有8505例患者，CMN队列中有8505例患者。倾向评分调整后的多变量回归模型评估SHS作为以下30天结果的独立危险因素：死亡率、术后主要和次要并发症、出院处置、再入院和再次手术、住院时间（LOS）和手术时间。
SHS和CMN之间在死亡率方面没有差异（p = 0.440）。与CMN相比，SHS队列发生次要并发症的可能性降低了11.6%（p < 0.001）；然而，在主要并发症方面，CMN和SHS之间没有差异（p = 0.117）。SHS患者输血（p < 0.001）、深静脉血栓形成（DVT，p = 0.007）和心肌梗死（MI，p = 0.024）的可能性较小。SHS患者回家的可能性高12.5%（p = 0.002）。未发现接受SHS治疗与再次手术（p = 0.449）和再入院（p = 0.588）之间存在关联。SHS患者的住院时间几乎长四分之一天（p = 0.041）。接受SHS治疗的患者手术时间长2分钟，具有统计学意义（p < 0.001），但临床意义不大。
III级。
