Abstract：
BACKGROUND: Recent literature suggests that fixation of trochanteric hip fractures with intramedullary nailing carries a higher 30-day mortality than with sliding hip screw. The present study aims to verify whether this statement is reflected in our practice.
METHODS: Sliding hip screw and intramedullary nail fixation of trochanteric hip fractures were analysed over a 5-year period, between April 2011 and March 2016. Three investigators independently analysed 919 patients. Data collected included 30-day mortality, OTA classification of hip fracture and ASA grading. Inclusion and exclusion criteria were applied.
RESULTS: 493 patients (66%) underwent sliding hip screw while 252 patients (34%) underwent intramedullary femoral nailing. AO/OTA classification was strongly associated with treatment group. It was found that 30-day mortality rate was 4.8% following intramedullary nailing compared to 6.1% with sliding hip screw. Multivariate logistic regression analysis found ASA grade, male gender and age to be associated with increased 30-day mortality with statistical significance. There was no statistically significant association between treatment group and 30-day mortality, nor between ASA grade and treatment group.
CONCLUSIONS: Both the lower 30-day mortality rate of 4.8% with intramedullary nailing and the higher rate of 6.1% with sliding hip screw fixation compare favourably with the mean 7.9% National 30-day mortality rate following hip fractures. The lower 30-day mortality in the intramedullary nailing group was not attributable to lower ASA grading nor due to simpler fracture configuration. ASA grade, male gender and age were shown to be statistically associated with increased 30-day mortality.
CONCLUSIONS: Previous studies may have deterred surgeons from choosing an intramedullary device. However, we hope this study assists surgeons to make an informed decision on the choice of implant particularly when an intramedullary device is required to provide a more stable construct.
METHODS: Sliding hip screw and intramedullary nail fixation of trochanteric hip fractures were analysed over a 5-year period, between April 2011 and March 2016. Three investigators independently analysed 919 patients. Data collected included 30-day mortality, OTA classification of hip fracture and ASA grading. Inclusion and exclusion criteria were applied.
RESULTS: 493 patients (66%) underwent sliding hip screw while 252 patients (34%) underwent intramedullary femoral nailing. AO/OTA classification was strongly associated with treatment group. It was found that 30-day mortality rate was 4.8% following intramedullary nailing compared to 6.1% with sliding hip screw. Multivariate logistic regression analysis found ASA grade, male gender and age to be associated with increased 30-day mortality with statistical significance. There was no statistically significant association between treatment group and 30-day mortality, nor between ASA grade and treatment group.
CONCLUSIONS: Both the lower 30-day mortality rate of 4.8% with intramedullary nailing and the higher rate of 6.1% with sliding hip screw fixation compare favourably with the mean 7.9% National 30-day mortality rate following hip fractures. The lower 30-day mortality in the intramedullary nailing group was not attributable to lower ASA grading nor due to simpler fracture configuration. ASA grade, male gender and age were shown to be statistically associated with increased 30-day mortality.
CONCLUSIONS: Previous studies may have deterred surgeons from choosing an intramedullary device. However, we hope this study assists surgeons to make an informed decision on the choice of implant particularly when an intramedullary device is required to provide a more stable construct.
摘要：
背景：最近的文献表明，髓内钉固定股骨粗隆间骨折的30天死亡率高于滑动髋螺钉。本研究旨在验证这一说法是否反映在我们的实践中。
方法：对5年的股骨粗隆间骨折的滑动髋螺钉和髓内钉固定进行分析，2011年4月至2016年3月。三名研究人员独立分析了919名患者。收集的数据包括30天死亡率，髋部骨折的OTA分级和ASA分级。采用纳入和排除标准。
结果：493例患者（66％）接受了滑动髋螺钉，而252例患者（34％）接受了股骨髓内钉。AO/OTA分类与治疗组密切相关。发现髓内钉后30天的死亡率为4.8％，而滑动髋螺钉为6.1％。多因素logistic回归分析发现ASA等级,男性性别和年龄与30天死亡率增加相关，具有统计学意义。治疗组与30天死亡率之间没有统计学上的显著关联。ASA等级和治疗组之间也没有。
结论：髓内钉的30天死亡率较低，为4.8％，而滑动髋螺钉内固定的30天死亡率较高，为6.1％，与平均7.9％的国家30天死亡率相比髋部骨折后的死亡率。髓内钉组30天死亡率较低，既不是由于ASA分级较低，也不是由于骨折构型较简单。ASA等级,研究显示,男性性别和年龄与30日死亡率增加有统计学相关.
结论：先前的研究可能阻碍了外科医生选择髓内装置。然而,我们希望这项研究能帮助外科医生对植入物的选择做出明智的决定,特别是当需要髓内装置来提供更稳定的结构时.
方法：对5年的股骨粗隆间骨折的滑动髋螺钉和髓内钉固定进行分析，2011年4月至2016年3月。三名研究人员独立分析了919名患者。收集的数据包括30天死亡率，髋部骨折的OTA分级和ASA分级。采用纳入和排除标准。
结果：493例患者（66％）接受了滑动髋螺钉，而252例患者（34％）接受了股骨髓内钉。AO/OTA分类与治疗组密切相关。发现髓内钉后30天的死亡率为4.8％，而滑动髋螺钉为6.1％。多因素logistic回归分析发现ASA等级,男性性别和年龄与30天死亡率增加相关，具有统计学意义。治疗组与30天死亡率之间没有统计学上的显著关联。ASA等级和治疗组之间也没有。
结论：髓内钉的30天死亡率较低，为4.8％，而滑动髋螺钉内固定的30天死亡率较高，为6.1％，与平均7.9％的国家30天死亡率相比髋部骨折后的死亡率。髓内钉组30天死亡率较低，既不是由于ASA分级较低，也不是由于骨折构型较简单。ASA等级,研究显示,男性性别和年龄与30日死亡率增加有统计学相关.
结论：先前的研究可能阻碍了外科医生选择髓内装置。然而,我们希望这项研究能帮助外科医生对植入物的选择做出明智的决定,特别是当需要髓内装置来提供更稳定的结构时.
