Valen Anders Kjærsgaard, Viberg Bjarke, Gundtoft Per Hviid, Wæver Daniel, Thorninger Rikke
Department of Orthopaedic Surgery and Traumatology, Regional Hospital Randers, Skovlyvej 15, 8930 Randers, Denmark.
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark.
Injury. 2023 Mar 12. doi: 10.1016/j.injury.2023.03.008.
Whether trochanteric hip fractures (AO/OTA 31-A) should be treated with an intramedullary nail (IMN) or sliding hip screw (SHS) is debated. Recent studies suggest an association between IMN and excess mortality rates compared to SHS, but higher quality studies fail to show this association. Furthermore, there is an increased usage of IMN with sparse evidence supporting this rise. Our aim was to compare mortality rates between IMN and SHS in patients with AO/OTA 31-A fractures. Secondarily, to investigate choice of implant in relation to fracture subtype.
This national registry study is based on data from the Danish Fracture Database (DFDB). Data were retrieved on patients aged ≥65 years treated for a non-pathological AO/OTA type 31-A fracture with IMN or SHS from January 1, 2012 to December 31, 2018. Data from DFDB were merged with data from the Danish Civil Registration System (CRS) for time of death. Mortality rates were recorded at 30 days, 90 days, and 1 year and presented as crude mortality and adjusted for age, gender, ASA-class, and AO/OTA-subtype.
A total of 9,547 patients were included. The mean age was 83 years, 69% were female, and 55% were ASA-class 3-5. We found higher mortality rates for IMN-patients at 30 days, 90 days, and 1 year. The crude relative mortality risk for IMN was also significantly higher at both 30 days (1.20) and 90 days (1.11). Adjusted relative mortality risk for IMN was 1.12 [0.96; 1.31] at 30-days, 1.03 [0.91; 1.17] at 90-days, and 1.01 [0.92; 1.11] at 1 year. Most patients suffered a 31-A2 fracture (56%) and, overall, 74% of patients were treated with IMN.
We found significantly increased crude relative mortality risk at 30 days and 90 days in patients treated with IMN. However, when adjusting for confounders the two groups had similar mortality risks. In total, 74% of all patients in this cohort were treated with IMN.
This study has level of evidence: III.
对于转子间髋部骨折（AO/OTA 31 - A型）应采用髓内钉（IMN）还是滑动髋螺钉（SHS）治疗存在争议。近期研究表明，与SHS相比，IMN与更高的死亡率相关，但更高质量的研究并未显示出这种关联。此外，IMN的使用有所增加，但支持这种增长的证据却很少。我们的目的是比较AO/OTA 31 - A型骨折患者中IMN和SHS的死亡率。其次，研究与骨折亚型相关的植入物选择。
这项全国性登记研究基于丹麦骨折数据库（DFDB）的数据。检索了2012年1月1日至2018年12月31日期间年龄≥65岁、因非病理性AO/OTA 31 - A型骨折接受IMN或SHS治疗的患者数据。DFDB的数据与丹麦民事登记系统（CRS）的死亡时间数据进行了合并。记录30天、90天和1年时的死亡率，并以粗死亡率表示，并根据年龄、性别、ASA分级和AO/OTA亚型进行调整。
共纳入9547例患者。平均年龄为83岁，69%为女性，55%为ASA 3 - 5级。我们发现IMN治疗的患者在30天、90天和1年时的死亡率更高。IMN的粗相对死亡风险在30天（1.20）和90天（1.11）时也显著更高。IMN在30天时的调整后相对死亡风险为1.12 [0.96; 1.31]，90天时为1.03 [0.91; 1.17]，1年时为1.01 [0.92; 1.11]。大多数患者为31 - A2型骨折（56%），总体而言，74%的患者接受了IMN治疗。
我们发现接受IMN治疗的患者在30天和90天时的粗相对死亡风险显著增加。然而，在对混杂因素进行调整后，两组的死亡风险相似。在该队列中，共有74%的患者接受了IMN治疗。
本研究的证据水平为：III级。
