Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures.
Factors Associated With Revision Surgery After Internal Fixation of Hip Fractures.
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DOI：
10.1097/bot.0000000000001162
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发表时间：
2018-05
影响因子：
2.3
通讯作者：
FAITH Investigators
中科院分区：
文献类型：
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作者：
Sprague S;Schemitsch EH;Swiontkowski M;Della Rocca GJ;Jeray KJ;Liew S;Slobogean GP;Bzovsky S;Heels-Ansdell D;Zhou Q;Bhandari M;FAITH Investigators
股骨颈骨折与内固定治疗后翻修手术的高发生率相关。使用来自FAITH试验的数据，评估股骨颈骨折患者的内固定方法，我们研究了基线和手术因素与术后24个月内翻修手术以促进愈合、缓解疼痛、治疗感染或改善功能的需求之间的相关性。此外，我们研究了与（1）硬件取出和（2）从松质骨螺钉（CS）或滑动髋螺钉（SHS）更换为全髋关节置换术、半髋关节置换术或其他内固定器械的植入物相关的因素。我们确定了15个可能与翻修手术相关的先验潜在因素，7个与硬件取出相关，14个与植入物更换相关。我们在研究中使用了多变量考克斯比例风险分析。与翻修手术风险增加相关的因素包括：女性，（风险比（HR）1.79，95%置信区间（CI）1.25-2.50; p=0.001），体重指数较高（每增加5分）（HR 1.19，95% CI 1.02-1.39; p=0.027），移位性骨折（HR 2.16，95% CI 1.44-3.23; p<0.001），种植体植入质量不可接受（HR 2.70，95% CI 1.59-4.55; p<0.001），以及接受CS治疗的吸烟者与接受SHS治疗的吸烟者（HR 2.94，95% CI 1.35-6.25; p=0.006）。此外，年龄每减少10岁，参与者的硬件移除风险平均增加39%。这项研究的结果可以通过识别高风险患者来为未来的研究提供信息，这些患者可能会更好地接受关节成形术治疗，并可能从早期护理中受益。II
Femoral neck fractures are associated with high rates of revision surgery following management with internal fixation. Using data from the FAITH trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24-months post-surgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. We identified 15 potential factors a priori that may be associated with revision surgery, seven with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Factors associated with increased risk of revision surgery included: female sex, (Hazard Ratio (HR) 1.79, 95% Confidence Interval (CI) 1.25–2.50; p=0.001), higher body mass index (for every 5-point increase) (HR 1.19, 95% CI 1.02–1.39; p=0.027), displaced fracture (HR 2.16, 95% CI 1.44–3.23; p<0.001), unacceptable quality of implant placement (HR 2.70, 95% CI 1.59–4.55; p<0.001), and smokers treated with CS versus smokers treated with a SHS (HR 2.94, 95% CI 1.35–6.25; p=0.006). Additionally, for every 10-year decrease in age, participants experienced an average increased risk of 39% for hardware removal. Results of this study may inform future research by identifying high risk patients who may be better treated with arthroplasty and may benefit from adjuncts to care. II