老年股骨远端骨折：内固定与一期关节置换的长期再手术率相当
Geriatric Distal Femur Fractures: Equivalent Long-Term Reoperation Rates Between Fixation and Primary Arthroplasty.
作者信息
Shi Brendan Y, Upfill-Brown Alexander, Brodke Dane J, Stavrakis Alexandra I, Lee Christopher, SooHoo Nelson F
机构信息
Department of Orthopaedic Surgery, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095.
出版信息
J Orthop Trauma. 2023 May 1;37(5):249. doi: 10.1097/BOT.0000000000002535.
OBJECTIVE
Our primary objectives were to (1) determine the rate of requiring conversion to arthroplasty after open reduction internal fixation (ORIF) of geriatric distal femur fractures and (2) compare 10-year reoperation rates after ORIF versus primary arthroplasty for geriatric distal femur fractures.
DESIGN
Propensity-matched retrospective cohort study.
SETTING
All centers participating in the California Office of Statewide Health Planning and Development (OSHPD) database.
PATIENTS/PARTICIPANTS: All patients 65 years of age or older who underwent operative management of a distal femur fracture between 2000 and 2017.
INTERVENTION
ORIF, total knee arthroplasty (TKA), or distal femur replacement (DFR).
MAIN OUTCOME MEASUREMENTS
Reoperation.
RESULTS
A total of 16,784 patients with geriatric distal femur fracture were identified, of which 16,343 (97.4%) underwent ORIF. The cumulative incidence of conversion to arthroplasty within 10 years of ORIF was found to be 3.5%, with young age and female sex identified as risk factors for conversion. There was no significant difference in 10-year reoperation-free survival rate between propensity-matched patients undergoing ORIF versus primary arthroplasty (94.5% vs. 96.2%, P = 0.659). There were no differences in short-term complication or readmission rates between matched treatment cohorts, but arthroplasty was associated with a higher rate of wound infection within 90 days (2.0% vs. 0.2%, P = 0.011).
CONCLUSIONS
The 10-year cumulative incidence of conversion to arthroplasty after ORIF was found to be low. There was no significant difference in long-term reoperation-free survival rates between patients undergoing ORIF versus primary arthroplasty. Primary arthroplasty was associated with significantly higher rates of acute wound or joint infection.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
目的
我们的主要目标是：（1）确定老年股骨远端骨折切开复位内固定术（ORIF）后需要转为关节置换术的比例；（2）比较老年股骨远端骨折ORIF与初次关节置换术后的10年再次手术率。
设计
倾向评分匹配的回顾性队列研究。
地点
所有参与加利福尼亚州全州卫生规划与发展办公室（OSHPD）数据库的中心。
患者/参与者：2000年至2017年间接受股骨远端骨折手术治疗的所有65岁及以上患者。
干预措施
ORIF、全膝关节置换术（TKA）或股骨远端置换术（DFR）。
主要观察指标
再次手术。
结果
共识别出16784例老年股骨远端骨折患者，其中16343例（97.4%）接受了ORIF。ORIF术后10年内转为关节置换术的累积发生率为3.5%，年轻和女性被确定为转为关节置换术的危险因素。倾向评分匹配的接受ORIF与初次关节置换术的患者10年无再次手术生存率无显著差异（94.5%对96.2%，P = 0.659）。匹配治疗队列之间的短期并发症或再入院率无差异，但关节置换术与90天内较高伤口感染率相关（2.0%对0.2%，P = 0.011）。
结论
发现ORIF术后转为关节置换术的10年累积发生率较低。接受ORIF与初次关节置换术的患者长期无再次手术生存率无显著差异。初次关节置换术与急性伤口或关节感染率显著较高相关。
证据水平
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
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