Kay Harrison F, Kang Hyunwoo P, Alluri Ram, Azad Ali, Ghiassi Alidad
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
J Hand Surg Am. 2020 May;45(5):427-432. doi: 10.1016/j.jhsa.2019.12.010. Epub 2020 Feb 20.
The primary objective of this study was to compare incidence, demographic trends, and rates of subsequent fusion between proximal row carpectomy (PRC) and 4-corner fusion (4CF) among patients in the United States.
A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from the years 2005 through 2014 among enrollees in the PearlDiver database. Regional distribution, demographic characteristics, annual incidence, comorbidities, and subsequent wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age- and sex-matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average direct cost.
Patients undergoing 4CF and PRC did not have statistically significant differences in comorbidities. The incidence of the procedures among all subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,000) from 2005 to 2014. Comparing the matched cohorts, patients who underwent 4CF had a higher rate of subsequent fusion than those who underwent PRC (2.67% vs 1.79%). Readmission rates were not significantly different at 30 or 90 days. Average direct cost was significantly greater for 4CF than for PRC.
Both PRC and 4CF have been utilized at increasing rates in the past decade. Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
本研究的主要目的是比较美国患者近端腕骨切除术（PRC）和四角融合术（4CF）之间的发病率、人口统计学趋势以及后续融合率。
从2005年至2014年PearlDiver数据库的参保者中，共识别出3636例行PRC的患者和5047例行4CF的患者。比较两组患者的区域分布、人口统计学特征、年发病率、合并症以及后续腕关节融合情况。在识别出的患者中，每组3512例进行年龄和性别匹配，随后比较融合转换率、30天和90天再入院率以及平均直接费用。
行4CF和PRC的患者在合并症方面无统计学显著差异。从2005年到2014年，所有参保者中这两种手术的发生率均有所增加，PRC从每10000人1.8例增至每10000人2.6例，4CF从每10000人1.2例增至每10000人2.0例。比较匹配队列，行4CF的患者后续融合率高于行PRC的患者（2.67%对1.79%）。30天或90天的再入院率无显著差异。4CF的平均直接费用显著高于PRC。
在过去十年中，PRC和4CF的应用率均在上升。4CF组的腕关节融合率和平均费用更高，而再入院率无显著差异。
研究类型/证据水平：治疗性III级。
