在骨骨折患者中,非化与化整形术和修复手术之间的关联
Kanu Okike1, Priscilla H Chan2, Heather A Prentice2
1Hawaii Permanente Medical Group, Kaiser Permanente, Honolulu.
JAMA
|March 18, 2020
概括
对于美国的关节骨折整形术,与固相比,未固的固定显示出更高的无菌修复风险. 外科医生应考虑对移位的股骨骨折进行固,除非有禁忌.
科学领域:
- 整形外科手术
- 生物材料科学
- 医疗服务研究
背景情况:
- 一致的指导方针表明凝固性骨关节整形在股骨骨折中是优越的.
- 之前的研究主要来自美国以外.
- 需要美国的具体数据来验证这些建议.
研究的目的:
- 在一个大型的美国医疗保健系统中比较水泥化和非水泥化骨关节整形的结果.
- 评估关节骨折的不同固定方法的有效性和安全性.
主要方法:
- 对12491名接受关节整形手术的患者 (≥60岁) 的回顾性队列研究 (2009 - 2017年).
- 混凝土固定与非混凝土固定的比较.
- 主要结局:无菌检查;次要结局:死亡率,并发症,再入院.
主要成果:
- 无固定与显著更高的无菌修订风险相关 (HR1. 77,P<. 001).
- 一年后无菌修复的累计发病率为非水泥制品的3. 0%,而水泥制品的1. 3%.
- 没有观察到死亡率或其他次要结果的显著差异.
结论:
- 在美国的大型医疗系统中,对于关节骨折的非水泥化整形术与更高的无菌修复率有关.
- 这些发现支持在美国对移位部骨折进行固的考虑.
- 如果没有非固的禁用,则固可能是首选选项.
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