In all, 1,609 patients (1,635 DRFs) with primary radiographs after a DRF between 2014 and 2017 at two Swedish hospitals were included in a retrospective cohort study. An estimation was made of the percentage of patients in the historical pre-guidelines cohort, that would have been recommended early primary surgery according to the new national guidelines compared to treatment implemented without the support of these guidelines.
On a strict radiological basis, 32% (516 out of 1635) of DRFs were classified into one of the 4 defined subgroups. At 9-13 days follow-up, cast treatment was converted into delayed primary surgery in 201 cases. Out of these, 56% (112 out of 201) fulfilled the fast-track criteria and would with the new guidelines have been subject to early primary surgery.
The fast-track regimen in the new guidelines, has a high likelihood of identifying the unstable fractures benefitting from early primary surgery. If the proposed Swedish national guidelines for DRF treatment are implemented, a greater proportion of fractures would be treated with early primary surgery, and a delayed surgery avoided in the majority of cases. The potential benefits in relation to possible costs when using the fast-track criteria in every day practice are still unknown.
总之,在一项回顾性队列研究中,纳入了2014年至2017年间在两家瑞典医院进行DRF检查后的1,609名患者(1,635名DRF)的主要X光片。对历史指南前队列中患者的百分比进行了估计,与在没有这些指南支持的情况下实施的治疗相比,根据新的国家指南,这将被建议进行早期初次手术。
在严格的放射学基础上,32%(1635个中的516个)的DRF被分为4个定义的亚组之一。随访9-13天,201例转换为延迟的原发性手术。在这些中,56%(201个中的112个)符合快速通道标准,并且在新指南下将接受早期初次手术。
新指南中的快速治疗方案,有很高的可能性确定不稳定的骨折受益于早期的初级手术。如果拟议的瑞典DRF治疗国家指南得到实施,更大比例的骨折将通过早期初次手术治疗,在大多数情况下避免了延迟手术。在日常实践中使用快速通道标准时,与可能的成本有关的潜在收益仍然未知。