Muhammad Maaz, Green Griffin, Southall Wyatt G S, Musick Adam N, Gregg Austin T, Wagner Robert K, Hawk Gregory S, Aneja Arun
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky.
JB JS Open Access. 2025 Sep 19;10(3). doi: 10.2106/JBJS.OA.25.00170. eCollection 2025 Jul-Sep.
Despite extensive literature comparing short and long cephalomedullary nails (CMNs), the impact of CMN length on pulmonary complications in geriatric patients with intertrochanteric (IT) fractures is not well established. This study compared postoperative pulmonary complications in geriatric patients with IT fractures treated with short (<235 mm) or intermediate (235-240 mm) CMNs (SINs) versus long (≥300 mm) CMNs (LNs).
Patients aged ≥65 years with AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31A1-A3 fractures treated with SINs or LNs between 2008 and 2020 were retrospectively identified at a single Level 1 Trauma center. The primary outcome was inpatient postoperative pulmonary complications. Secondary outcomes included mortality, surgical duration, and other inpatient postoperative complications. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated using logistic regression to adjust for comorbidities (i.e., diabetes, hypertension, chronic) obstructive pulmonary disease, smoking status, age, AO/OTA classification, ASA ≥3, time to surgery, and surgical duration.
Overall, 881 patients were treated with either an SIN (n = 327) or an LN (n = 554). The SIN group was older (80.7 ± 9.1 years vs. 79.3 ± 8.4 years, p = 0.016), had a higher proportion of AO/OTA 31A1 fractures (p < 0.001), and included more patients with ASA ≥3 (89% vs. 84%, p = 0.035). In the SIN group, the median surgical duration was shorter (60 [interquartile range (IQR): 47-79] vs. 81 minutes [IQR: 62-106], p < 0.001), and rates of postoperative anemia (74% vs. 81%, p = 0.017) and transfusion (43% vs. 54%, p = 0.001) were lower. After adjusting for covariates, multivariable analysis demonstrated increased odds of postoperative pneumonia (AOR: 2.09, 95% CI: 1.01-4.71, p = 0.048), pulmonary embolism (AOR: 4.38, 95% CI: 1.09-29.5, p = 0.036), and transfusion (AOR: 1.38, 95% CI: 1.02-1.85, p = 0.034) in the LN group. There were no differences in mortality or other postoperative complications (p > 0.05).
Geriatric patients with IT fractures treated with LNs had increased odds of inpatient postoperative pneumonia, pulmonary embolism, and transfusion. However, mortality and other postoperative complications were similar.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管有大量文献比较了短和长的股骨近端髓内钉（CMN），但CMN长度对老年转子间（IT）骨折患者肺部并发症的影响尚未明确。本研究比较了接受短（<235 mm）或中（235 - 240 mm）CMN（SIN）与长（≥300 mm）CMN（LN）治疗的老年IT骨折患者的术后肺部并发症。
在一家一级创伤中心对2008年至2020年间接受SIN或LN治疗的年龄≥65岁的AO基金会/骨科创伤协会（AO/OTA）31A1 - A3骨折患者进行回顾性识别。主要结局是住院术后肺部并发症。次要结局包括死亡率、手术时间和其他住院术后并发症。使用逻辑回归计算调整后的优势比（AOR）及95%置信区间（CI），以调整合并症（即糖尿病、高血压、慢性阻塞性肺疾病、吸烟状况、年龄、AO/OTA分类、ASA≥3、手术时间和手术时长）。
总体而言，881例患者接受了SIN（n = 327）或LN（n = 554）治疗。SIN组患者年龄更大（80.7±9.1岁 vs. 79.3±8.4岁，p = 0.016），AO/OTA 31A1骨折比例更高（p < 0.001），且ASA≥3的患者更多（89% vs. 84%，p = 0.035）。SIN组的中位手术时间更短（60[四分位间距（IQR）：47 - 79] vs. 81分钟[IQR：62 - 106]，p < 0.001），术后贫血（74% vs. 81%，p = 0.017）和输血率（43% vs. 54%，p = 0.001）更低。在调整协变量后，多变量分析显示LN组术后肺炎（AOR：2.09，95%CI：1.01 - 4.71，p = 0.048）、肺栓塞（AOR：4.38，95%CI：1.09 - 29.5，p = 0.036）和输血（AOR：1.38，95%CI：1.02 - 1.85，p = 0.034）的优势比增加。死亡率或其他术后并发症无差异（p > 0.05）。
接受LN治疗的老年IT骨折患者术后发生肺炎、肺栓塞和输血的几率增加。然而，死亡率和其他术后并发症相似。
治疗性三级。有关证据水平的完整描述，请参阅作者指南。
