Patterson Joseph T, Ishii Keisuke, Tornetta Paul, Leighton Ross K, Friess Darin M, Jones Clifford B, Levine Ari, Maclean Jeffrey J, Miclau Theodore, Mullis Brian H, Obremskey William T, Ostrum Robert F, Reid J Spence, Ruder John A, Saleh Anas, Schmidt Andrew H, Teague David C, Tsismenakis Antonios, Westberg Jerald R, Morshed Saam
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA.
J Orthop Trauma. 2020 Jun;34(6):294-301. doi: 10.1097/BOT.0000000000001711.
To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation.
Retrospective cohort study with radiograph and chart review.
Twelve Level 1 North American trauma centers.
Two hundred thirty-four adults 18-65 years of age with an isolated, displaced, OTA/AO type 31-B2 or type 31-B3 femoral neck fracture treated with internal fixation with minimum of 6-month follow-up or reoperation. Exclusion criteria were pathologic fractures, associated femoral head or shaft fractures, and primary arthroplasty.
Open or closed reduction technique during internal fixation.
Cox proportional hazard of reoperation adjusting for propensity score for open reduction based on injury, demographic, and medical factors. Reduction quality was assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs.
Median follow-up was 1.5 years. One hundred six (45%) patients underwent open reduction. Reduction quality was not significantly affected by open versus closed approach (71% vs. 69% acceptable, P = 0.378). The propensity to receive an open reduction was associated with study center; younger age; male sex; no history of injection drug use, osteoporosis, or cerebrovascular disease; transcervical fracture location; posterior fracture comminution; and surgery within 12 hours. A total of 35 (33%) versus 28 (22%) reoperations occurred after open versus closed reduction (P = 0.056). Open reduction was associated with a 2.4-fold greater propensity-adjusted hazard of reoperation (95% confidence interval 1.3-4.4, P = 0.004). A total of 35 (15%) patients underwent subsequent total hip arthroplasty or hemiarthroplasty.
Open reduction of displaced femoral neck fractures in nonelderly adults is associated with a greater hazard of reoperation without significantly improving reduction. Prospective randomized trials are indicated to confirm a causative effect of open versus closed reduction on outcomes after femoral neck fracture.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定（1）哪些因素与选择切开复位相关，以及（2）通过对这些因素进行调整后，复位方法的选择是否与再次手术相关。
通过回顾X线片和病历进行的回顾性队列研究。
12家北美一级创伤中心。
234名年龄在18 - 65岁之间的成年人，患有孤立的、移位的OTA/AO 31 - B2型或31 - B3型股骨颈骨折，接受内固定治疗，随访至少6个月或再次手术。排除标准为病理性骨折、合并股骨头或股骨干骨折以及初次关节置换术。
内固定期间采用切开或闭合复位技术。
根据损伤、人口统计学和医学因素对切开复位倾向评分进行调整后，再次手术的Cox比例风险。由3名资深骨科创伤专家在术后前后位和侧位X线片上评估复位质量为“可接受”或“不可接受”。
中位随访时间为1.5年。106例（45%）患者接受了切开复位。切开与闭合入路对复位质量无显著影响（可接受率分别为71%和69%，P = 0.378）。接受切开复位的倾向与研究中心、年龄较小、男性、无注射吸毒史、无骨质疏松症或脑血管疾病史、经颈骨折部位、后方骨折粉碎以及12小时内手术有关。切开复位后与闭合复位后分别有35例（33%）和28例（22%）再次手术（P = 0.056）。切开复位与倾向调整后的再次手术风险高2.4倍相关（95%置信区间1.3 - 4.4，P = 0.004）。共有35例（15%）患者随后接受了全髋关节置换术或半髋关节置换术。
非老年成年人移位股骨颈骨折的切开复位与再次手术风险增加相关，且未显著改善复位效果。需要进行前瞻性随机试验以证实切开与闭合复位对股骨颈骨折后结局的因果关系。
治疗性III级。有关证据水平的完整描述，请参阅《作者须知》。
