老年人和中年人群中，因原发性和辅助性治疗髋臼骨折而行急性全髋关节置换术的发病率上升。
Rising incidence of acute total hip arthroplasty for primary and adjunctive treatment of acetabular fracture in older and middle-aged adults.
机构信息
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA.
Department of Orthopaedic Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
出版信息
Eur J Orthop Surg Traumatol. 2024 Oct;34(7):3509-3521. doi: 10.1007/s00590-023-03653-4. Epub 2023 Jul 22.
BACKGROUND
Acute total hip arthroplasty (THA) may be an alternative or an adjuvant to internal fixation for surgical treatment of acetabular fractures. We investigate recent trends in the operative management of acetabular fractures. We hypothesize that the incidence of acute THA for acetabular fractures has increased over time.
METHODS
4569 middle-aged (45-64 years) and older adults (≥ 65 years) who received acute operative management of an acetabular fracture within 3 weeks of admission between 2010 and 2020 were identified from the United States Nationwide Inpatient Sample database. Treatment was classified as open reduction internal fixation (ORIF), THA, or combined ORIF and THA (ORIF + THA). Patients were stratified by age ≥ 65 years old. Associations between demographic factors and the incidence of each procedure over the study period were modeled using linear regression.
RESULTS
The relative incidence of treatments was 80.9% ORIF, 12.1% THA, and 7.0% ORIF + THA. Among patients aged 45-64 years old, THA increased 4.8% [R = 0.62; β = 0.6% (95% Confidence Interval (CI) 0.2-0.9%)] and ORIF + THA increased 2.6% [R = 0.73; β = 0.3% (95% CI 0.2-0.4%)], while the use of ORIF decreased 7.4% [R = 0.75; β = -0.9% (95% CI -1.2 to -0.5%)]. Among patients ≥ 65 years old, THA increased 16.5% [R = 0.87; β = 1.7% (95% CI 1.2-2.2%)] and ORIF + THA increased 5.0% [R = 0.38, β = 0.6% (95% CI 0.0-1.3%)], while ORIF decreased 21.5% [R = 0.75; β = -2.4% (95% CI -3.45 to -1.3%)].
CONCLUSION
The treatment of acetabular fractures with acute THA has increased in the last decade, particularly among older adults.
背景
急性全髋关节置换术（THA）可能是髋臼骨折手术治疗的内固定的替代或辅助方法。我们研究了髋臼骨折手术治疗的最新趋势。我们假设，随着时间的推移，髋臼骨折行急性 THA 的发生率有所增加。
方法
从美国全国住院患者样本数据库中确定了 2010 年至 2020 年期间在入院后 3 周内接受急性髋臼骨折手术治疗的 4569 名中年（45-64 岁）和老年人（≥65 岁）患者。治疗分为切开复位内固定术（ORIF）、THA 或 ORIF 和 THA 联合治疗（ORIF+THA）。根据年龄≥65 岁将患者分层。使用线性回归分析研究期间每个治疗程序的发生率与人口统计学因素之间的关联。
结果
ORIF、THA 和 ORIF+THA 的治疗相对发生率分别为 80.9%、12.1%和 7.0%。在 45-64 岁的患者中，THA 增加了 4.8%[R=0.62；β=0.6%（95%置信区间（CI）0.2-0.9%）]，ORIF+THA 增加了 2.6%[R=0.73；β=0.3%（95% CI 0.2-0.4%）]，而 ORIF 减少了 7.4%[R=0.75；β=-0.9%（95% CI -1.2 至-0.5%）]。在≥65 岁的患者中，THA 增加了 16.5%[R=0.87；β=1.7%（95% CI 1.2-2.2%）]，ORIF+THA 增加了 5.0%[R=0.38，β=0.6%（95% CI 0.0-1.3%）]，而 ORIF 减少了 21.5%[R=0.75；β=-2.4%（95% CI -3.45 至-1.3%）]。
结论
在过去十年中，急性 THA 治疗髋臼骨折的方法有所增加，尤其是在老年人中。
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