Improved outcome after hip fracture surgery in Norway 10-year results from the Norwegian Hip Fracture Register
Improved outcome after hip fracture surgery in Norway 10-year results from the Norwegian Hip Fracture Register
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DOI：
10.1080/17453674.2017.1344456
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发表时间：
2017-01-01
影响因子：
3.7
通讯作者：
Engesaeter, Lars B.
中科院分区：
文献类型：
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作者：
Gjertsen, Jan-Erik;Dybvik, Eva;Engesaeter, Lars B.
背景和目的-在过去的十年中，挪威髋部骨折的手术治疗发生了很大的变化。我们使用挪威髋关节骨折登记处的数据，调查这些变化对再手术和1年mortals.Patients和方法的可能影响- 72,741股骨颈（FFN）骨折和转子骨折的患者60岁或以上进行了分析。骨折分为5个时间段（2005-2006年、2007-2008年、2009-2010年、2011-2012年、2013-2014年）。考克斯回归模型被用来计算未调整和调整（年龄组，性别和阿萨类）的相对风险（RR）的再手术和1年死亡率在不同的时间periods.Results -对于未移位FFN治疗半关节置换术从2.1%增加到9.7%，在研究期间。对于移位的FFN，关节成形术治疗从56%增加到93%。对于稳定的双碎片（AO/OTA A1）转子骨折，髓内钉的使用从9.1%增加到26%，对于多碎片（AO/OTA A2）转子骨折，髓内钉的使用从15%增加到33%，对于转子间骨折（AO/OTA A3）/转子下骨折，髓内钉的使用从27%增加到61%。与第一个时间段相比，最后一个时间段内移位的FFN再手术的调整后1年RR为0.43（95% CI：0.37-0.49）。所有骨折在最后一个时间段的调整后1年死亡率较低（RR：0.87（0.83-0.91）），FFN移位（RR：0.86（0.80-0.93）），AO/OTA A1转子骨折（RR：0.79（0.71-0.88））和AO/OTA A2转子骨折（RR：0.87（0.77-0.98））。解释-挪威的髋部骨折治疗有所改善：移位股骨颈骨折后再次手术的风险和1年死亡率在10年内有所下降。国家登记有助于监测髋部骨折后的治疗和结局趋势。
Background and purpose - The operative treatment of hip fractures in Norway has changed considerably during the last decade. We used data in the Norwegian Hip Fracture Register to investigate possible effects of these changes on reoperations and 1-year mortality.Patients and methods - 72,741 femoral neck (FFN) fractures and trochanteric fractures in patients 60 years or older were analyzed. The fractures were divided into 5 time periods (2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014). Cox regression models were used to calculate unadjusted and adjusted (age group, sex, and ASA class) relative risks (RRs) of reoperation and of 1-year mortality in the different time periods.Results - For undisplaced FFNs treatment with hemiarthroplasty increased from 2.1% to 9.7% during the study period. For displaced FFNs treatment with arthroplasty increased from 56% to 93%. The use of intramedullary nails increased from 9.1% to 26% for stable 2-fragment (AO/OTA A1) trochanteric fractures, from 15% to 33% for multifragment (AO/OTA A2) trochanteric fractures, and from 27% to 61% for intertrochanteric fractures (AO/OTA A3)/subtrochanteric fractures. Compared with the first time period the adjusted 1-year RR for reoperation was 0.43 (95% CI: 0.37-0.49) for displaced FFNs in the last time period. The adjusted 1-year mortality in the last time period was lower for all fractures (RR: 0.87 (0.83-0.91)), displaced FFNs (RR: 0.86 (0.80-0.93)), AO/OTA A1 trochanteric fractures (RR: 0.79 (0.71-0.88)), and AO/OTA A2 trochanteric fractures (RR: 0.87 (0.77-0.98)) when compared with the first study period.Interpretation - Hip fracture treatment in Norway has improved: The risk of reoperation and the 1-year mortality after displaced femoral neck fractures have decreased over a 10-year period. National registration is useful to monitor trends in treatment and outcomes after hip fractures.