Özdemir Erdi, Okkaoglu Mustafa Caner, Evren Ali Teoman, Yaradilmis Yuksel Ugur, Ates Ahmet, Altay Murat
University of Health Sciences, Ankara Kecioren Training and Research Hospital, Pınarbaşı Mah., Sanatoryum Caddesi Ardahan Sokak D:25, 06280 Keçiören, Ankara Turkey.
Indian J Orthop. 2021 Jan 3;55(3):629-635. doi: 10.1007/s43465-020-00322-0. eCollection 2021 Jun.
We aimed to evaluate the cost and consequences of failed osteosynthesis of intertrochanteric femur fracture (ITFF) patients and compare with primary ITFF patients.
We retrospectively evaluated 689 patients who underwent surgery due to ITFF via cephalomedullary nail. 31 patients (5.8%) had revision surgery because of osteosynthesis failure of ITFF. Each revision case included in the study was matched with four primary ITFF cases as control group based on age, gender, year of operation, type of fracture and American Society of Anesthesiologists (ASA) grade. Total cost for the admission that patients underwent surgery, mortality rate at first year, infection rate, length of stay at hospital, length of stay at intensive care unit, and erythrocyte transfusion amounts were recorded from hospital registry records. Tip apex distances (TAD) were noted.
The mean total cost of the revision cases and primary cases was 10,027 ± 6387 and 5261 ± 1773 Turkish Liras, respectively ( < 0.001). TAD was ≥ 20 mm in 32.3% (10/31) of patients in revision group while 2.4% (3/124) of the patients in control group ( < 0.001). The mean length of stay at hospital, length of stay at intensive care unit, erythrocyte transfusion amounts, infection rate and mortality rate at first year were significantly higher in revision cases compared to matched primary control cases ( < 0.05).
Revision surgeries due to failed osteosynthesis of ITFFs with cephalomedullary nail have at least two times higher mean total cost than primary cases. The awareness of the cost, morbidity and mortality of the revision surgeries may reduce the modifiable risk factors of osteosynthesis failure including maintenance of TAD below 20 mm, obtaining optimal lag screw position and reduction quality.
Level 3, retrospective cohort study.
我们旨在评估股骨转子间骨折（ITFF）患者接骨术失败的成本和后果，并与初次ITFF患者进行比较。
我们回顾性评估了689例因ITFF接受髓内钉手术的患者。31例（5.8%）患者因ITFF接骨术失败而接受翻修手术。研究纳入的每例翻修病例根据年龄、性别、手术年份、骨折类型和美国麻醉医师协会（ASA）分级与4例初次ITFF病例作为对照组进行匹配。从医院登记记录中记录患者接受手术的住院总费用、第一年死亡率、感染率、住院时间、重症监护病房住院时间和红细胞输注量。记录尖顶距离（TAD）。
翻修病例和初次病例的平均总费用分别为10,027±6387和5261±1773土耳其里拉（P<0.001）。翻修组32.3%（10/31）的患者TAD≥20 mm，而对照组为2.4%（3/124）（P<0.001）。与匹配的初次对照病例相比，翻修病例的平均住院时间、重症监护病房住院时间、红细胞输注量、感染率和第一年死亡率显著更高（P<0.05）。
因髓内钉治疗ITFF接骨术失败而进行的翻修手术的平均总费用至少是初次病例的两倍。了解翻修手术的成本、发病率和死亡率可能会降低接骨术失败的可改变风险因素，包括将TAD维持在20 mm以下、获得最佳拉力螺钉位置和复位质量。
3级，回顾性队列研究。
