背景:肱骨头是骨坏死的第二常见部位,股骨头后。然而,与股骨头坏死(ONFH)相比,有关肱骨头骨坏死(ONHH)的流行病学信息很少。我们假设,肩关节与髋关节的生物力学特性不同,ONHH的流行病学特征可能与ONFH的流行病学特征不同。为了评估流行病学差异,我们使用大韩民国(ROK)的全国医疗索赔数据库比较了ONHH和ONFH手术治疗的趋势.
方法:我们分析了2008年至2018年韩国健康保险审查和评估(HIRA)数据库中的流行病学数据。HIRA数据库包含几乎所有匿名形式的医疗信息,包括人口统计,诊断,以及外科手术的类型,通过韩国的医疗保健实践产生的。ONHH和ONFH的年发病率是根据一般人群的总数计算的。人口统计,年发病率,根据解剖部位和受影响年份比较创伤后骨坏死的比例和手术方法。
结果:研究期间接受ONHH和ONFH治疗的患者总数分别为1,028和66,260。尽管ONHH的发病率增加,与ONFH相比,这是一种相对罕见的疾病。ONHH在女性中更常见,而ONFH主要发生在男性患者(p<0.001)。ONHH的手术治疗最常见于老年患者(63.7%),而中年患者的ONFH比例最高(48.9%,p<0.001)。ONHH(5.1%)的创伤后骨坏死的比例明显高于ONFH(1.9%,p<0.001)。ONHH(96.0%)比ONFH(92.9%,p<0.001)。
结论:尽管髋关节和肩关节在解剖学上有相似之处,不同的生物力学特性,如承重功能,可能导致ONHH和ONFH之间的流行病学差异。
BACKGROUND: The humeral head is the second most common site of osteonecrosis, after the femoral head. However, compared to osteonecrosis of the femoral head (ONFH), epidemiological information on osteonecrosis of the humeral head (ONHH) is scarce. We hypothesised that different biomechanical properties of the shoulder from the hip joint might present different epidemiological characteristics of ONHH from those of the ONFH. To evaluate epidemiological differences, we compared trends in the surgical treatment of ONHH and ONFH using the nationwide medical claims database of the Republic of Korea (ROK).
METHODS: We analysed epidemiological data from the Health Insurance Review and Assessment (HIRA) database of the ROK between 2008 and 2018. HIRA database contains almost all medical information in an anonymised form, including demographics, diagnoses, and types of surgical procedures, generated through healthcare practices in ROK. The annual incidence rates of ONHH and ONFH were calculated based on the total number of the general population. Demographics, annual incidence, and the proportion of post-traumatic osteonecrosis and surgical procedures were compared according to the anatomical site and the affected year.
RESULTS: The total number of patients treated for ONHH and ONFH during the study period was 1,028 and 66,260, respectively. Although the incidence of ONHH increased, it is a relatively rare disease compared to ONFH. ONHH occurred more frequently in females, while ONFH occurred predominantly in male patients (p < 0.001). Surgical treatment for ONHH was most frequently performed in older patients (63.7%), whereas middle-aged patients had the largest proportion of ONFH (48.9%, p < 0.001). The proportion of post-traumatic osteonecrosis was significantly higher in the ONHH (5.1%) than in the ONFH (1.9%, p < 0.001). Arthroplasty was performed more frequently in the ONHH (96.0%) than in the ONFH (92.9%, p < 0.001).
CONCLUSIONS: Despite the anatomical similarities between the hip and shoulder joints, the different biomechanical properties, such as weight-bearing functions, might cause epidemiological differences between ONHH and ONFH.