髓内钉股骨颈保护在低能量股骨干骨折中的再手术风险降低。

Reduced Risk of Reoperation Using Intramedullary Nailing with Femoral Neck Protection in Low-Energy Femoral Shaft Fractures.

机构信息

Department of Orthopedic Surgery, Gävle Hospital, Gävle, Sweden.

Department of Orthopedics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

出版信息

J Bone Joint Surg Am. 2020 Sep 2;102(17):1486-1494. doi: 10.2106/JBJS.20.00160.

DOI:10.2106/JBJS.20.00160

PMID:32701713

Abstract

BACKGROUND

In Sweden, approximately 1 in 4 women who are ≥50 years of age will sustain a hip fracture. Patients treated for a femoral shaft fracture are likely to have an even higher risk. We hypothesized that intramedullary nails protecting the femoral neck reduce the risk of subsequent hip fracture and allow the patient to avoid a challenging reoperation.

METHODS

Between 2008 and 2010, 5,475 fractures of the femoral shaft, in patients who were ≥55 years of age, were registered in a national registry in Sweden. Of these patients, 897 fulfilled the inclusion criteria. We used radiographs and register data to identify the reasons for and the types of reoperation that occurred between the index surgical procedure and December 31, 2014. The categories of implants were determined through a review of radiographs as intramedullary nails with and without femoral neck protection. Reoperations related to peri-implant fractures (including hip fractures) were analyzed as a subgroup of all major reoperations. Multivariable-adjusted, cause-specific hazard ratios (HRs) were calculated to compare the risk of reoperation between cases with nails with and without femoral neck protection.

RESULTS

Among the 897 patients, a total of 82 reoperations were performed. In 640 patients who were treated with intramedullary nails with femoral neck protection, there were 7 peri-implant fractures (no hip fractures) and 27 major reoperations. Among the 257 patients who were treated with intramedullary nails without femoral neck protection, 14 peri-implant hip fractures and 24 major reoperations were identified. Patients who received nails with femoral neck protection had a lower hazard for any peri-implant fracture (multivariable-adjusted cause-specific HR, 0.19 [95% confidence interval (CI), 0.07 to 0.5]) and major reoperation (multivariable-adjusted cause-specific HR, 0.51 [95% CI, 0.28 to 0.92]).

CONCLUSIONS

Intramedullary nails with femoral neck protection in the treatment of low-energy femoral shaft fractures prevent secondary hip fractures and decrease the overall risk of reoperation for 4 to 6 years postoperatively.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

在瑞典，大约每 4 名≥50 岁的女性中就有 1 人会发生髋部骨折。股骨粗隆间骨折患者发生髋部骨折的风险甚至更高。我们假设髓内钉保护股骨颈可以降低随后发生髋部骨折的风险，并使患者避免进行具有挑战性的再次手术。

方法

在 2008 年至 2010 年间，瑞典全国注册中心登记了 5475 例≥55 岁股骨粗隆间骨折患者。其中 897 例符合纳入标准。我们使用 X 线片和注册数据来确定索引手术和 2014 年 12 月 31 日之间进行的再手术的原因和类型。通过 X 线片评估植入物的类型，确定有和没有股骨颈保护的髓内钉。分析与植入物周围骨折（包括髋部骨折）相关的再手术作为所有主要再手术的亚组。采用多变量校正的特定原因风险比（HR）来比较有和没有股骨颈保护的髓内钉治疗患者的再手术风险。

结果

在 897 例患者中，共进行了 82 次再手术。在 640 例接受有股骨颈保护的髓内钉治疗的患者中，有 7 例发生了植入物周围骨折（无髋部骨折）和 27 例主要再手术。在 257 例接受无股骨颈保护的髓内钉治疗的患者中，发现 14 例植入物周围髋部骨折和 24 例主要再手术。接受有股骨颈保护的髓内钉治疗的患者发生任何植入物周围骨折的风险较低（多变量校正的特定原因 HR，0.19[95%置信区间（CI），0.07 至 0.5]）和主要再手术（多变量校正的特定原因 HR，0.51[95%CI，0.28 至 0.92]）。