Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Iowa Orthop J. 2023 Dec;43(2):163-171.
Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality.
A retrospective query using a nationwide database was performed. Patients undergoing SHS or IMN for intertrochanteric fractures were identified. The query yielded a total of 37,929 patients utilizing SHS (n = 11,665) or IMN (n = 26,264). Patients were matched 1:1 based on comorbidities. Primary outcomes included: utilization trends, patient demographics, 90-day complications, and 90-day readmission rates. Linear regression analyses were used to compare utilization trends. Pearson's c2 analyses were used to compare patient-demographics, medical complications, and 90-day readmission rates. A p-value less than 0.05 was considered statistically significant.
Linear regression analysis demonstrated a statistically significant decrease in utilization of SHS for IT fractures (p<0.0001); whereas utilization for IMN stayed consistent (p=0.36). IMN had significantly higher prevalence of comorbidities compared to SHS, notably, hyperlipidemia (70.6 vs. 62.6%; p<0.0001). Based on 1:1 match, IMN patients had significantly higher rates of 90-day medical complications, such as respiratory failure (11.0 vs. 8.1%; p<0.0001) and VTE (4.2 vs. 3.2%; p<0.001; however, there was not a statistical difference in postoperative infection (1.4 vs. 1.5%, p=0.06). There was no statistical difference in 90-day mortality between IMN and SHS cohorts (0.19 vs .13%, p = 0.249).
This analysis demonstrates a difference in utilization of SHS and IMN for patients with IT fractures. Patients with IMN had significantly higher prevalence of comorbid conditions and incidence of 90-day postoperative complications compared to SHS patients. The study can be utilized by orthopaedic surgeons to potentially anticipate healthcare utilization depending on implant selection. .
研究表明，在美国，股骨转子间骨折的发病率有所上升。在 Medicare 人群中，评估使用滑动髋螺钉 (SHS) 或髓内钉 (IMN) 治疗股骨转子间骨折的匹配研究有限。本研究旨在调查：1) 年度利用趋势；2) 患者人口统计学特征；3) 包括死亡率在内的并发症。
使用全国性数据库进行回顾性查询。确定了接受 SHS 或 IMN 治疗股骨转子间骨折的患者。该查询共获得了 37929 名使用 SHS（n=11665）或 IMN（n=26264）的患者。根据合并症对患者进行 1:1 匹配。主要结果包括：利用趋势、患者人口统计学特征、90 天并发症和 90 天再入院率。线性回归分析用于比较利用趋势。Pearson's c2 分析用于比较患者人口统计学特征、医疗并发症和 90 天再入院率。p 值小于 0.05 被认为具有统计学意义。
线性回归分析表明，SHS 治疗 IT 骨折的使用率呈统计学显著下降（p<0.0001）；而 IMN 的使用率保持稳定（p=0.36）。与 SHS 相比，IMN 患者的合并症患病率显著更高，特别是高脂血症（70.6%比 62.6%；p<0.0001）。根据 1:1 匹配，IMN 患者 90 天医疗并发症发生率显著更高，例如呼吸衰竭（11.0%比 8.1%；p<0.0001）和 VTE（4.2%比 3.2%；p<0.001）；然而，术后感染率无统计学差异（1.4%比 1.5%，p=0.06）。IMN 和 SHS 队列之间 90 天死亡率无统计学差异（0.19%比 0.13%，p=0.249）。
本分析表明，在股骨转子间骨折患者中，SHS 和 IMN 的使用存在差异。与 SHS 患者相比，IMN 患者的合并症患病率和 90 天术后并发症发生率显著更高。该研究可供骨科医生根据植入物选择预测医疗保健的利用情况。
