Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China.
JAMA Netw Open. 2020 Aug 3;3(8):e205830. doi: 10.1001/jamanetworkopen.2020.5830.
The outcomes of surgical treatment in patients with intertrochanteric hip fractures are unsatisfactory. Computer-assisted virtual preoperative planning may provide an opportunity to solve this treatment dilemma. Virtual preoperative planning is a technique based on dynamic 3-dimensional computed tomographic imaging, which allows precise evaluation of fracture details and simulation of reduction of fracture and internal fixation procedures before surgery is performed.
To evaluate the association of computer-assisted virtual preoperative planning with the risk of 90-day all-cause mortality and postoperative complications.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted from using patient data from a level 1 trauma center database. A total of 1445 patients 65 years and older with intertrochanteric hip fractures between January 1, 2009, and March 31, 2018, were identified and divided into 2 cohorts: 558 patients received computer-assisted virtual preoperative planning (virtual planning group), and 887 patients received conventional preoperative planning (conventional planning group). Of the initial 1445 patients, 224 patients (93 patients in the virtual planning group and 131 patients in the conventional planning group) were excluded, resulting in 1221 patients in the final cohort. Data were analyzed from April 5 to October 5, 2019.
Computer-assisted virtual vs conventional surgical preoperative planning.
Primary outcomes were 90-day all-cause mortality and postoperative complications (including myocardial infarction, heart failure, stroke, kidney failure, and sepsis). Secondary outcomes were 90-day outpatient visits, hospital readmissions, and reoperations.
Among 1221 patients who underwent hip surgery, the mean (SD) age was 73.2 (12.3) years, and 927 patients (75.9%) were women. A total of 465 patients (38.1%) were in the virtual planning group and 756 patients (61.9%) were in the conventional planning group. Among the 814 patients (407 patients in each group) who were matched by propensity score, the virtual planning group had a lower incidence of mortality (37 patients [9.1%] vs 55 patients [13.5%]; hazard ratio [HR], 0.64; 95% CI, 0.41-0.99; P = .04) and postoperative complications (25 patients [6.1%] vs 44 patients [10.8%]; HR, 0.54; 95% CI, 0.32-0.90; P = .02) compared with the conventional planning group. The incidence of outpatient visits was not substantially different in the virtual planning group (1.51 incidents per 30 person-days) compared with the conventional planning group (1.48 incidents per 30 person-days; incidence rate ratio [IRR], 0.90; 95% CI, 0.49-1.68; P = .75). Similar results were observed for the rate of hospital readmissions (0.99 incidents per 30 person-days in the virtual planning group and 1.01 incidents per 30 person-days in the conventional planning group; IRR, 0.91; 95% CI, 0.49-1.67; P = .76). However, the rate of reoperations was lower in the virtual planning group (0.76 incidents per 30 person-days) than in the conventional planning group (0.97 incidents per 30 person-days; IRR, 0.41; 95% CI, 0.22-0.76; P = .01).
Among older patients with intertrochanteric hip fractures, computer-assisted virtual preoperative planning was associated with decreases in the risks of all-cause 90-day mortality, postoperative complications, and reoperations compared with conventional preoperative planning.
手术治疗转子间髋部骨折的效果并不理想。计算机辅助虚拟术前规划可能提供了解决这一治疗难题的机会。虚拟术前规划是一种基于动态三维计算机断层成像的技术，允许在手术前精确评估骨折细节并模拟骨折复位和内固定过程。
评估计算机辅助虚拟术前规划与 90 天全因死亡率和术后并发症风险的关系。
设计、设置和参与者：这是一项回顾性队列研究，使用来自 1 级创伤中心数据库的患者数据进行。共纳入 2009 年 1 月 1 日至 2018 年 3 月 31 日期间 1445 名年龄 65 岁及以上的转子间髋部骨折患者，分为 2 个队列：558 例接受计算机辅助虚拟术前规划（虚拟规划组），887 例接受常规术前规划（常规规划组）。在最初的 1445 名患者中，224 名患者（虚拟规划组 93 名，常规规划组 131 名）被排除，最终队列中有 1221 名患者。数据于 2019 年 4 月 5 日至 10 月 5 日进行分析。
计算机辅助虚拟与常规手术术前规划。
主要结局是 90 天全因死亡率和术后并发症（包括心肌梗死、心力衰竭、中风、肾衰竭和败血症）。次要结局是 90 天门诊就诊、医院再入院和再次手术。
在接受髋关节手术的 1221 名患者中，平均（SD）年龄为 73.2（12.3）岁，927 名（75.9%）为女性。共 465 名（38.1%）患者在虚拟规划组，756 名（61.9%）患者在常规规划组。在 814 名（407 名患者每组）按倾向评分匹配的患者中，虚拟规划组死亡率较低（37 例[9.1%]与 55 例[13.5%]；风险比[HR]，0.64；95%CI，0.41-0.99；P=0.04），术后并发症也较低（25 例[6.1%]与 44 例[10.8%]；HR，0.54；95%CI，0.32-0.90；P=0.02）。与常规规划组相比，虚拟规划组的门诊就诊次数差异不显著（每 30 人天 1.51 次）（每 30 人天 1.48 次；发生率比[IRR]，0.90；95%CI，0.49-1.68；P=0.75）。对于医院再入院率，也观察到类似的结果（虚拟规划组每 30 人天 0.99 次，常规规划组每 30 人天 1.01 次；IRR，0.91；95%CI，0.49-1.67；P=0.76）。然而，虚拟规划组的再手术率较低（每 30 人天 0.76 次），常规规划组每 30 人天 0.97 次（IRR，0.41；95%CI，0.22-0.76；P=0.01）。
在老年转子间髋部骨折患者中，与常规术前规划相比，计算机辅助虚拟术前规划可降低 90 天全因死亡率、术后并发症和再手术的风险。
