Equivalent mortality after operation with sliding hip screw or intramedullary nail for trochanteric AO/OTA A1 and A2 fractures reported in the Norwegian Hip Fracture Register 2008 to 2020.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2024-06-01 DOI:10.1302/0301-620X.106B6.BJJ-2023-1219.R1

Amara Ahmad, Emma H Egeland, Eva H Dybvik, Jan-Erik Gjertsen, Stein A Lie, Anne M Fenstad, Kjell Matre, Ove Furnes

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引用次数: 0

Abstract

Aims: This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.

Methods: We analyzed data from 26,393 patients with trochanteric AO/OTA A1 and A2 fractures treated with IMNs (n = 9,095) or SHSs (n = 17,298) in the Norwegian Hip Fracture Register (January 2008 to December 2020). Exclusions were made for patients aged < 60 years, pathological fractures, pre-2008 operations, contralateral hip fractures, fractures other than trochanteric A1/A2, and treatments other than IMNs or SHSs. Kaplan-Meier and Cox regression analyses adjusted for type of fracture, age, sex, cognitive impairment, American Society of Anesthesiologists (ASA) grade, and time period were conducted, along with calculations for number needed to harm (NNH).

Results: In unadjusted analyses, there was no significant difference between IMN and SHS patient survival at 30 days (91.8% vs 91.1%; p = 0.083) or 90 days (85.4% vs 84.5%; p = 0.065), but higher one-year survival for IMNs (74.5% vs 73.3%; p = 0.031) compared with SHSs. After adjustments, no significant difference in 30-day mortality was found (hazard rate ratio (HRR) 0.94 (95% confidence interval (CI) 0.86 to 1.02(; p = 0.146). IMNs exhibited higher mortality at 0 to 1 days (HRR 1.63 (95% CI 1.13 to 2.34); p = 0.009) compared with SHSs, with a NNH of 556, but lower mortality at 8 to 30 days (HRR 0.89 (95% CI 0.80 to 1.00); p = 0.043). No differences were observed in mortality at 2 to 7 days (HRR 0.94 (95% CI 0.79 to 1.11); p = 0.434), 90 days (HRR 0.95 (95% CI 0.89 to 1.02); p = 0.177), or 365 days (HRR 0.97 (95% CI 0.92 to 1.02); p = 0.192).

Conclusion: This study found no difference in 30-day mortality between IMNs and SHSs. However, IMNs were associated with a higher mortality at 0 to 1 days and a marginally lower mortality at 8 to 30 days compared with SHSs. The observed differences in mortality were small and should probably not guide choice of treatment.

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2008 年至 2020 年挪威髋部骨折登记册中报告的转子 AO/OTA A1 和 A2 骨折患者使用滑动髋关节螺钉或髓内钉手术后的同等死亡率。

目的：本研究旨在比较使用髓内钉（IMN）或滑动髋螺钉（SHS）治疗转子 AO/OTA A1 和 A2 骨折的死亡率。主要终点为30天死亡率，次要终点为0至1天、2至7天、8至30天、90天和365天死亡率：我们分析了挪威髋部骨折登记（2008年1月至2020年12月）中26,393名接受IMN（9,095人）或SHS（17,298人）治疗的转子AO/OTA A1和A2骨折患者的数据。排除了年龄小于60岁、病理性骨折、2008年前手术、对侧髋部骨折、转子A1/A2以外的骨折以及IMN或SHS以外治疗方法的患者。根据骨折类型、年龄、性别、认知障碍、美国麻醉医师协会（ASA）分级和时间段进行了卡普兰-梅耶分析和考克斯回归分析，并计算了伤害所需人数（NNH）：在未经调整的分析中，IMN 和 SHS 患者的 30 天存活率（91.8% vs 91.1%；p = 0.083）或 90 天存活率（85.4% vs 84.5%；p = 0.065）无显著差异，但与 SHS 相比，IMN 患者的一年存活率更高（74.5% vs 73.3%；p = 0.031）。经调整后，30 天死亡率无明显差异（危险率比 (HRR) 0.94（95% 置信区间 (CI) 0.86 至 1.02）；p = 0.146）。与 NNH 为 556 的 SHS 相比，IMN 在 0 至 1 天的死亡率较高（HRR 1.63（95% CI 1.13 至 2.34）；p = 0.009），但在 8 至 30 天的死亡率较低（HRR 0.89（95% CI 0.80 至 1.00）；p = 0.043）。2至7天（HRR 0.94 (95% CI 0.79 to 1.11)；p = 0.434）、90天（HRR 0.95 (95% CI 0.89 to 1.02)；p = 0.177）或365天（HRR 0.97 (95% CI 0.92 to 1.02)；p = 0.192）的死亡率无差异：本研究发现，IMN 和 SHS 的 30 天死亡率没有差异。然而，与 SHS 相比，IMN 在 0 至 1 天的死亡率较高，而在 8 至 30 天的死亡率略低。观察到的死亡率差异较小，可能不会对治疗方法的选择产生指导作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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