Ramsay Niamh, Close Jacqueline C T, Harris Ian A, Harvey Lara A
School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
ANZ J Surg. 2023 Jul-Aug;93(7-8):1917-1923. doi: 10.1111/ans.18562. Epub 2023 Jun 14.
Intramedullary (IM) nail fixation for intertrochanteric fractures is potentially associated with improved postoperative function but may have an increased mortality risk compared to sliding hip screw (SHS) fixation. This study investigated postoperative mortality risk between surgical fixation type for intertrochanteric fracture in patients aged 50 years and older using linked data from the Australian Hip Fracture Registry and National Death Index.
Descriptive analysis and Kaplan-Meier survival curves performed unadjusted analysis of mortality and fixation type (short IM nail, long IM nail and SHS). Multilevel logistic regression (AMLR) and Cox modelling (CM) performed adjusted analysis of fixation type and mortality following surgery. Instrumental variable analysis (IVA) was conducted to minimize the effect of unknown confounders.
The 30-day mortality was 7.1% for short IM, 7.8% for long IM and 7.8% for SHS fixation (P = 0.2). The AMLR demonstrated significant increase in 30-day mortality risk for long IM nail compared to short IM nail (OR = 1.2, 95% CI = 1.0-1.4, P < 0.05) but no significant difference for SHS fixation (OR = 1.1, 95% CI = 0.9-1.3, P = 0.5). No significant difference between groups and postoperative mortality was demonstrated by the CM at 30-days nor 1-year nor by the IVA at 30-days.
Despite a significant increase in 30-day mortality risk for long IM nail compared to short IM nail fixation in the adjusted analysis, this was not demonstrated in the CM nor IVA indicating the role of confounders influencing the regression findings. There was no significant association in 1-year mortality between long IM nail and SHS compared to short IM nail fixation.
髓内（IM）钉固定治疗粗隆间骨折可能会改善术后功能，但与滑动髋螺钉（SHS）固定相比，可能会增加死亡风险。本研究利用澳大利亚髋部骨折登记处和国家死亡指数的关联数据，调查了50岁及以上粗隆间骨折患者手术固定类型之间的术后死亡风险。
描述性分析和Kaplan-Meier生存曲线对死亡率和固定类型（短IM钉、长IM钉和SHS）进行了未调整分析。多水平逻辑回归（AMLR）和Cox模型（CM）对固定类型和术后死亡率进行了调整分析。进行了工具变量分析（IVA）以尽量减少未知混杂因素的影响。
短IM钉固定的30天死亡率为7.1%，长IM钉固定为7.8%，SHS固定为7.8%（P = 0.2）。AMLR显示，与短IM钉相比，长IM钉的30天死亡风险显著增加（OR = 1.2，95%CI = 1.0 - 1.4，P < 0.05），但SHS固定无显著差异（OR = 1.1，95%CI = 0.9 - 1.3，P = 0.5）。CM在30天、1年时均未显示出组间和术后死亡率的显著差异，IVA在30天时也未显示出显著差异。
尽管在调整分析中，与短IM钉固定相比，长IM钉固定的30天死亡风险显著增加，但CM和IVA均未显示出这一点，这表明混杂因素对回归结果有影响。与短IM钉固定相比，长IM钉和SHS在1年死亡率方面没有显著关联。
