技术失误对50岁以下成人手术治疗股骨颈骨折结局的影响。

Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age.

作者信息

Collinge Cory A, Finlay Andrea, Harris Payton, Rodriguez-Buitrago Andres, de la Fuente Guadalupe, Beltran Michael, Mitchell Phillip, Archdeacon Michael, Tornetta Paul, Mir Hassan R, Gardner Michael, Sagi H Claude, LeBus George F, Cannada Lisa K, Smyth Brooke

机构信息

Department of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, Fort Worth, TX.

Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System.

出版信息

J Orthop Trauma. 2023 May 1;37(5):214-221. doi: 10.1097/BOT.0000000000002562.

DOI:10.1097/BOT.0000000000002562

PMID:36728471

Abstract

OBJECTIVE

To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults.

DESIGN

Multicenter retrospective clinical study.

SETTING

26 North American Level 1 Trauma Centers.

PATIENTS

Skeletally mature patients younger than 50 years of age with 492 femoral neck fractures treated between 2005 and 2017.

INTERVENTION

Operative repair of femoral neck fracture.

MAIN OUTCOME MEASUREMENTS

The association between TE (malreduction and deviation from optimal technique) and treatment failure (fixation failure, nonunion, malunion, osteonecrosis, malunion, and revision surgery) were examined using logistic regression analysis.

RESULTS

Overall, a TE was observed in 50% (n = 245/492) of operatively managed femoral neck fractures in young patients. Two or more TEs were observed in 10% of displaced fractures. Treatment failure in displaced fractures occurred in 27% of cases without a TE, 56% of cases with 1 TE, and 86% of cases with 2 or more TEs. TEs were encountered less frequently in treatment of nondisplaced fractures compared with displaced fractures (39% vs. 53%, P < 0.001). Although TE(s) in nondisplaced fractures increased the risk of treatment failure and/or major reconstructive surgery (22% vs. 9%, P < 0.001), they were less frequently associated with treatment failure when compared with displaced fractures with a TE (22% vs. 69% P < 0.001).

CONCLUSIONS

TEs were found in half of all femoral neck fractures in young adults undergoing operative repair. Both the occurrence and number of TEs were associated with an increased risk for failure of treatment. Preoperative planning for thoughtful and well-executed reduction and fixation techniques should lead to improved outcomes for young patients with femoral neck fractures. This study should also highlight the need for educational forums to address this subject.

LEVEL OF EVIDENCE

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

摘要

目的

评估技术失误（TEs）对年轻成人股骨颈骨折修复术后结果的影响。

设计

多中心回顾性临床研究。

地点

26家北美一级创伤中心。

患者

2005年至2017年间接受治疗的492例年龄小于50岁的骨骼成熟的股骨颈骨折患者。

干预措施

股骨颈骨折的手术修复。

主要观察指标

使用逻辑回归分析检查TE（复位不良和偏离最佳技术）与治疗失败（内固定失败、骨不连、畸形愈合、骨坏死、畸形愈合和翻修手术）之间的关联。

结果

总体而言，在接受手术治疗的年轻患者股骨颈骨折中，50%（n = 245/492）观察到TE。在10%的移位骨折中观察到两个或更多TE。移位骨折的治疗失败在无TE的病例中发生率为27%，有1个TE的病例中为56%，有2个或更多TE的病例中为86%。与移位骨折相比，非移位骨折治疗中TE的发生率较低（39%对53%，P < 0.001）。尽管非移位骨折中的TE增加了治疗失败和/或重大重建手术的风险（22%对9%，P < 0.001），但与有TE的移位骨折相比，它们与治疗失败的关联较少（22%对69%，P < 0.001）。