Rischen Robert, Köppe Jeanette, Stolberg-Stolberg Josef, Freistühler Moritz, Faldum Andreas, Raschke Michael J, Katthagen J Christoph
Clinic for Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany.
Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany.
J Clin Med. 2023 Feb 10;12(4):1440. doi: 10.3390/jcm12041440.
The surgical treatment of proximal humeral fractures (PHFs) with locking plate fixation (LPF) in the elderly is associated with high complication rates, especially in osteoporotic bone. Variants of LPF such as additional cerclages, double plating, bone grafting and cement augmentation can be applied. The objective of the study was to describe the extent of their actual use and how this changed over time.
Retrospective analysis of health claims data of the Federal Association of the Local Health Insurance Funds was performed, covering all patients aged 65 years and older, who had a coded diagnosis of PHF and were treated with LPF between 2010 and 2018. Differences between treatment variants were analyzed (explorative) via chi-squared or Kruskal-Wallis tests.
Of the 41,216 treated patients, 32,952 (80%) were treated with LPF only, 5572 (14%) received additional screws or plates, 1983 (5%) received additional augmentations and 709 (2%) received a combination of both. During the study period, relative changes were observed as follows: -35% for LPF only, +58% for LPF with additional fracture fixation and +25% for LPF with additional augmentation. Overall, the intra-hospital complication rate was 15% with differences between the treatment variants (LPF only 15%, LPF with additional fracture fixation 14%, LPF with additional augmentation 19%; < 0.001), and a 30-day mortality of 2%.
Within an overall decrease of LPF by approximately one-third, there is both an absolute and relative increase of treatment variants. Collectively, they account for 20% of all coded LPFs, which might indicate more personalized treatment pathways. The leading variant was additional fracture fixation using cerclages.
老年肱骨近端骨折（PHF）采用锁定钢板固定（LPF）的手术治疗并发症发生率较高，尤其是在骨质疏松性骨中。可以应用LPF的变体，如额外的环扎、双钢板、植骨和骨水泥强化。本研究的目的是描述其实际使用程度以及随时间的变化情况。
对地方医疗保险基金联邦协会的健康索赔数据进行回顾性分析，涵盖所有65岁及以上、编码诊断为PHF且在2010年至2018年间接受LPF治疗的患者。通过卡方检验或克鲁斯卡尔 - 沃利斯检验（探索性）分析治疗变体之间的差异。
在41216例接受治疗的患者中，32952例（80%）仅接受LPF治疗，5572例（14%）接受了额外的螺钉或钢板，1983例（5%）接受了额外的强化，709例（2%）接受了两者的联合治疗。在研究期间，观察到的相对变化如下：仅LPF治疗下降35%，LPF加额外骨折固定增加58%，LPF加额外强化增加25%。总体而言，院内并发症发生率为15%，治疗变体之间存在差异（仅LPF治疗为15%，LPF加额外骨折固定为14%，LPF加额外强化为19%；<0.001），30天死亡率为2%。
在LPF总体减少约三分之一的情况下，治疗变体在绝对和相对方面均有所增加。总体而言，它们占所有编码LPF的20%，这可能表明治疗途径更加个性化。主要变体是使用环扎进行额外的骨折固定。
