Department of Traumatology and Hand Surgery, Faculty of Medicine, Clinical Centre, University of Pécs, Pécs, Hungary.
Baranya County Government Office, Pécs, Hungary.
Injury. 2021 Mar;52 Suppl 1:S31-S36. doi: 10.1016/j.injury.2020.02.055. Epub 2020 Feb 11.
To investigate the correlation between non-operative prognostic factors and non-prosthetic fracture-related treatments following internal fixation of intracapsular femoral neck fractures in elderly patients.
Retrospective observational cohort study. Comprehensive analysis of the Hungarian nationwide health insurance database.
Data of in-patient records with S7200 ICD-10 codes were collected from the Hungarian National Health Insurance Fund Administration (HNHIFA) and from the health care provider institutes. The patients with femoral neck fractures in the year of 2000, following reduction and internal fixation aged 60 years or older were evaluated. The secondary, non-prosthetic fracture related treatments during the 8 year follow-up period were registered.
Of the prognostic factors, age, gender, type of fracture, season and day of the primary surgery, length of waiting time to the operation and the accompanied diseases were evaluated as risk factors for all type of fracture-related further interventions, with the exception of arthroplasties.
A total of 2895 patients with intracapsular femoral neck fractures met the study criteria. The mean age was 77.96 years (SD: 8.54). The cohort of the patients was observed for a total of 10,077.8 person-years. The non-prosthetic fracture related treatment was performed in 265 patients (9,2%); the median of the time elapsed to the secondary definitive treatment was 3.5 months. With Cox regression analysis, significant correlation was revealed between the incidence of non-prosthetic treatment and younger age (year, HR = 0.977, p = 0.002), surgical delay (12-24 h vs 0-6 h, HR = 1.518, p = 0.023; 24h+ vs 0-6 h, HR = 1.372, p = 0.050), season of primary osteosynthesis (fall vs summer, HR = 0.636, p = 0.012), and type of femoral neck fracture (intracapsular displaced vs intracapsular undisplaced, HR = 1.340, p = 0,047). There was no significant effect of the day of primary surgery, the gender and the presence of co-morbidities on the incidence of further surgical interventions.
The summertime primary surgical intervention, delay of surgery longer than 12 h and type of femoral neck fracture are independent predictors of non-prosthetic further treatment of femoral neck fractures in elderly patients.
Level IV, evidence from cohort studies.
探讨老年患者股骨颈囊内骨折内固定术后非假体相关骨折治疗的非手术预后因素的相关性。
回顾性观察队列研究。对匈牙利全国健康保险数据库进行综合分析。
从匈牙利国家健康保险基金管理局（HNHIFA）和医疗机构收集 2000 年 S7200 ICD-10 编码的住院记录数据。评估了 60 岁或以上行复位内固定的股骨颈骨折患者。在 8 年的随访期间，记录了继发性非假体相关骨折治疗情况。
在预后因素中，年龄、性别、骨折类型、初次手术的季节和日期、手术等待时间以及伴随疾病被评估为所有类型骨折相关进一步干预的危险因素，但关节置换术除外。
共有 2895 例股骨颈囊内骨折患者符合研究标准。平均年龄为 77.96 岁（标准差：8.54）。该患者队列共观察了 10077.8 人年。265 例（9.2%）患者接受了非假体相关治疗；继发性确定性治疗的中位时间为 3.5 个月。通过 Cox 回归分析，非假体治疗的发生率与年龄较小（年，HR=0.977，p=0.002）、手术延迟（12-24 小时与 0-6 小时，HR=1.518，p=0.023；24 小时+与 0-6 小时，HR=1.372，p=0.050）、初次骨合成的季节（秋季与夏季，HR=0.636，p=0.012）和股骨颈骨折类型（囊内移位与囊内未移位，HR=1.340，p=0.047）显著相关。初次手术日期、性别和合并症的存在对进一步手术干预的发生率无显著影响。
夏季初次手术干预、手术时间超过 12 小时以及股骨颈骨折类型是老年患者股骨颈骨折非假体进一步治疗的独立预测因素。
四级，队列研究证据。
