■为了识别患者,外科医生,与术前计算机断层扫描(CT)扫描对桡骨远端骨折(DRF)的应用相关的损伤特征。此外,我们的目的是确定术前CT是否与孤立的掌侧锁定钢板(VLP)以外的治疗方法相关.
■我们回顾性审查了2016年至2020年在我们的医疗保健系统中所有手术治疗的成人DRF。基线人口统计,损伤,治疗特点,并记录了44名包括在内的外科医生的研究金培训。我们比较了有和没有术前CT的病例,并生成调整后的逻辑回归模型来确定术前CT的几率.
■共纳入由44名外科医生进行的1,204例手术治疗的DRF。在研究期间,CT利用率增加。关节内骨折占病例的76%,1240例中243例(20%),术前进行CT扫描。总的来说,83%的病例使用了孤立的VLP。术前CT的病例更有可能采用其他固定方法(例如背侧钢板)进行治疗。调整后的logistic回归模型显示男性(OR1.62;95%CI:1.16,2.26),关节内骨折(OR3.11;95%CI:1.87,5.81),和相关骨折(OR2.69;95%CI:1.82,3.98)的术前CT发生率显著增加.研究金培训与整体CT利用率的增加无关,但手外科医师更有可能在骨科创伤协会-C3骨折中使用CT。
■患者和损伤特征与手术DRF中的CT使用相关。术前CT与其他固定方法相关,因为有CT的病例更有可能使用除孤立VLP以外的固定方法。CT扫描的成本和收益必须仔细权衡这种方式是否增加价值或改善治疗DRF的结果。
■预后II.
UNASSIGNED: To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP).
UNASSIGNED: We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT.
UNASSIGNED: A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures.
UNASSIGNED: Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs.
UNASSIGNED: Prognostic II.