Surgical Treatment of Proximal Femoral Fractures - A Training Intervention?
Surgical Treatment of Proximal Femoral Fractures - A Training Intervention?
复制标题
DOI：
10.1055/s-0032-1328395
复制
发表时间：
2013-04-01
影响因子：
1
通讯作者：
Buecking, B.
中科院分区：
文献类型：
--
作者：
Bliemel, C.;Oberkircher, L.;Buecking, B.
背景：股骨近端骨折在老年人中很常见。手术和术后并发症在这一人群中非常重要。到目前为止，可以确定许多影响治疗结果的因素。外科医生的经验在教育地位方面的影响还没有完全弄清楚。本研究的目的是分析外科医生的教育程度对股骨近端骨折预后的影响。因此，根据个别外科医生的经验来比较治疗结果。材料与方法：在国家创伤中心，对60岁以上股骨近端骨折患者进行前瞻性筛查。在入院时收集患者特有的参数，如Barthel指数、ASA评分、Charlson评分、患者年龄和骨折类型。在骨折治疗的住院期间，记录手术时间、输血次数、围手术期并发症、住院时间和住院死亡率。根据外科医生的教育程度，对接骨和假体的结果进行分析。四组不同的外科医生被区分出来(缺乏经验的高级内科医生；有经验的高级内科医生；矫形外科和事故外科专家；具有特殊事故外科额外资格的矫形外科和事故外科专家)。结果：402例髋部骨折患者可纳入研究。160例(40%)出现不同程度的并发症。住院死亡率为6.2%。单独考虑骨接合和假体，发现四组外科医生在死亡率、输血次数和住院时间方面没有差异。结论：除切割缝合时间外，外科医生的学历对并发症发生率、输血率、住院死亡率和住院天数无统计学意义的影响。可以推测，按照我们的教育理念，外科教育对股骨近端骨折患者的治疗质量没有负面影响。切割/缝合时间的不同暗示了与外科教育相关的额外费用。
Background: Proximal femoral fractures are common in the elderly. Surgical and postoperative complications are of major importance in this population. Numerous factors affecting the treatment results could be identified so far. The effect of surgeons' experience in terms of educational status is not entirely clarified yet. The aim of the present study was to analyse the effect of surgeons' educational status on the outcome in proximal femoral fractures. Therefore treatment results were compared in terms of individual surgeons' experience. Furthermore, the surgical education concept of our department was evaluated.Material and Methods: At a national trauma centre, patients of at least 60 years of age with proximal femoral fractures were prospectively screened. Patient-specific parameters like Barthel index, ASA score, Charlson score, patients' age and type of fracture were collected at the time of hospital admission. During the in-hospital stay type of fracture treatment, surgery time, number of blood transfusions, perioperative complications, duration of in-hospital stay as well as in-hospital mortality were recorded.Results were analysed for osteosynthesis and prosthesis depending on the surgeons' educational status. Four different groups of surgeons were distinguished (inexperienced senior house officer; experienced senior house officer; specialist in orthopaedics and accident surgery; specialist in orthopaedics and accident surgery with an additional qualification for special accident surgery). Results: 402 patients with coxal femoral fractures could be included into the study. 160 patients (40%) sustained complications of different severity. In-hospital mortality was shown to be 6.2%. Separate consideration of osteosynthesis and prosthesis revealed no difference between the four groups of surgeons regarding mortality rate, number of blood transfusions and in-hospital stay. In terms of cutting/suture time consultants with a further specialisation in trauma surgery were significantly faster.Conclusion: Apart from cutting/suture time, surgeons' educational status had no statistically significant impact on the rate of complications, rate of blood transfusions, hospital mortality and in-hospital stay. It can be presumed that surgical education according to our educational concept has no negative effects on treatment quality of patients with proximal femoral fractures. Differences in cutting/suture time give a hint for the additional expense that is connected with surgical education.