The Ohio State University Wexner Medical Center, Columbus, USA.
Hand (N Y). 2022 Nov;17(6):1177-1186. doi: 10.1177/1558944720975147. Epub 2020 Dec 21.
The purpose of this study was to determine agreement with the American Academy of Orthopaedic Surgery Appropriate Use Criteria (AUC) for distal radius fractures (DRFs), before and after their adoption, and secondarily determine predictors of operative management.
A single-institution retrospective cohort study comparing patients treated either nonoperatively (115 patients) or operatively (767 patients) for DRFs between May 1, 2008, and May 1, 2018, by 8 hand surgeons was performed. Data included demographics, injury characteristics, DRF radiographic measurements, treatment rendered, and their appropriateness according to the AUC. Statistical testing used the Fisher and χ tests, test, and multiple variable logistic regression, with a significance level of .05.
Overall, there was a significant increase in AUC agreement for operatively treated DRFs (82.7%-89.3%, = .01), but no difference in agreement for nonoperatively treated DRFs (12.5%-10.7%, = .77). Age <80 years, AO classes other than B, intra-articular displacement >1 mm, radial inclination <18°, high-energy mechanism of injury, and greater than 1 week to treatment were independent predictors of operative treatment. The area under the curve for the validated regression model using the aforementioned predictors was 0.82.
Agreement with AUC for DRFs increased after its adoption for operatively treated, but not for nonoperatively treated, fractures. In addition, a predictive model for operative treatment was developed and validated. Future studies may benefit from further model refinement and testing in other patient cohorts.
本研究旨在确定在采用美国骨科协会（AOS）适当使用标准（AUC）前后，桡骨远端骨折（DRF）的治疗方案与该标准的符合程度，并进一步确定手术治疗的预测因素。
这是一项单中心回顾性队列研究，比较了 2008 年 5 月 1 日至 2018 年 5 月 1 日期间由 8 位手外科医生治疗的 115 例非手术治疗和 767 例手术治疗的 DRF 患者。数据包括人口统计学、损伤特征、DRF 影像学测量、治疗方法以及根据 AUC 确定的治疗方法的适宜性。统计检验采用 Fisher 和 χ 检验、 检验和多变量逻辑回归，显著性水平为.05。
总体而言，手术治疗的 DRF 符合 AUC 的比例显著增加（82.7%-89.3%， =.01），但非手术治疗的 DRF 符合 AUC 的比例没有差异（12.5%-10.7%， =.77）。年龄<80 岁、AO 分型非 B、关节内移位>1mm、桡骨倾斜度<18°、高能损伤机制和治疗时间超过 1 周是手术治疗的独立预测因素。使用上述预测因素的验证回归模型的曲线下面积为 0.82。
AUC 采用后，手术治疗的 DRF 与 AUC 的符合程度提高，但非手术治疗的 DRF 符合程度没有提高。此外，还制定并验证了一个手术治疗的预测模型。未来的研究可能受益于在其他患者队列中进一步改进和测试该模型。
