非典型股骨骨折再次手术率增高与患者特征有关，而与骨折类型无关。一项全国性队列研究。
Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study.
机构信息
Department of Orthopedic Surgery, Gävle Hospital, Lasarettsvägen 5, SE-80324, Gävle, Sweden.
Department of Orthopedics and Experimental and Clinical Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden.
出版信息
Osteoporos Int. 2020 May;31(5):951-959. doi: 10.1007/s00198-019-05249-3. Epub 2020 Jan 13.
UNLABELLED
Atypical femoral fractures are burdened with a high rate of reoperation. In our nationwide analysis, the increased rate of reoperation was related to patient background characteristics, such as age and health status, rather than fracture type.
INTRODUCTION
Patients with atypical fractures are complex to treat and burdened with a high risk of reoperation. We hypothesized that patients with surgically treated, complete atypical fractures have a higher risk of any reoperation and reoperation related to healing complications than patients with common femoral shaft fractures but that this increase would become insignificant when adjusted for predefined characteristics.
METHODS
A cohort of 163 patients with atypical fractures and 862 patients with common femoral shaft or subtrochanteric fractures treated from 2008 to 2010 and who had follow-up radiographs and register data available until 31 December 2014 was included. Reoperations were identified by a complementary review of radiographs and register data and were used to calculate risks for any reoperation and reoperations related to healing complications.
RESULTS
Patients with atypical fractures were more likely to be reoperated for any reason, age-adjusted OR 1.76 (95% CI, 1.08 to 2.86). However, patients with common fractures had a shorter follow-up due to a threefold higher death rate. Accordingly, in a multivariable-adjusted time-to-event model, the increased risk lost statistical significance for any reoperations, cause-specific HR 1.34 (95% CI, 0.85 to 2.13), and for reoperations related to healing complications, HR 1.32 (95% CI, 0.58 to 3.0). Continued use of bisphosphonate in the first year after the fracture did not affect the reoperation rate.
CONCLUSIONS
Our findings suggest that the increased risk of reoperation after an atypical femur fracture is largely explained by patient characteristics and not fracture type.
未加标签
非典型股骨骨折再手术率较高。在我们的全国性分析中，再手术率的增加与患者的背景特征有关，如年龄和健康状况，而与骨折类型无关。
引言
治疗非典型骨折的患者较为复杂，再手术风险较高。我们假设，与普通股骨干或转子下骨折患者相比，接受手术治疗的完全性非典型骨折患者有更高的任何再手术风险和与愈合并发症相关的再手术风险，但当根据预定义特征进行调整时，这种增加将变得无统计学意义。
方法
纳入了 2008 年至 2010 年接受治疗且随访影像学和登记数据截至 2014 年 12 月 31 日的 163 例非典型骨折患者和 862 例普通股骨干或转子下骨折患者组成的队列。通过对影像学和登记数据的补充审查来确定再手术，并计算任何再手术和与愈合并发症相关的再手术的风险。
结果
非典型骨折患者更有可能因任何原因而接受再手术，年龄调整后的 OR 为 1.76（95%CI，1.08 至 2.86）。然而，由于骨折患者的死亡率高 3 倍，因此随访时间更短。因此，在多变量调整的时间事件模型中，任何再手术的风险增加失去统计学意义，原因特异性 HR 为 1.34（95%CI，0.85 至 2.13），与愈合并发症相关的再手术 HR 为 1.32（95%CI，0.58 至 3.0）。骨折后第一年继续使用双膦酸盐不会影响再手术率。
结论
我们的研究结果表明，非典型股骨骨折后再手术风险的增加主要是由患者特征而不是骨折类型解释的。
Zotero 插件