TRAUMA
Prognostic factors for predicting outcomes after intramedullary nailing of the tibia
تم تحديد هذه الدراسة على أنها ذات تأثير كبير محتمل.
يُقدّر مقياس التأثير العالي الذي يعتمد على الذكاء الاصطناعي من OE التأثير المحتمل لورقة بحثية ما من خلال دمج الإشارات من كل من المجلة التي نُشرت فيها والمحتوى العلمي للمقالة نفسها.
تم تطوير نموذج OE High Impact باستخدام أحدث تقنيات معالجة اللغة الطبيعية، ويتنبأ نموذج OE High Impact بدقة أكبر بأداء الاقتباس المستقبلي للدراسة أكثر من معامل تأثير المجلة وحده.
وهذا يتيح التعرف المبكر على الأبحاث ذات المغزى السريري ويساعد القراء على التركيز على المقالات التي من المرجح أن تشكل الممارسة المستقبلية.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):117 J Bone Joint Surg Am. 2012 Oct 3;94(19):1786-93. doi: 10.2106/JBJS.J.01418.1226 patients who were included in the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) and completed the 1 year follow-up were included in this study to identify prognostic factors for predicting negative outcomes of this treatment. Multivariable logistic regression analysis identified an increased risk of a negative event for high energy fractures, stainless steel nails vs titanium nails, fracture gaps, full postoperative weight bearing, and open fractures treated with reamed nailing from the 15 baseline and surgical factors investigated.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
3/4
Randomization
4/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
The surgical fixation of tibial shaft fractures using intramedullary nail has become common practice, however, the choice between reamed and unreamed intramedullary nails has remained controversial. A recent study (SPRINT) investigated the outcomes of the use of reamed and unreamed intramedullary nails in the treatment tibial shaft fractures. Further assessments of baseline and surgical factors that may influence the risk of negative outcomes were needed to facilitate optimal patient care and guide treatment practices.
ما هو سؤال البحث الرئيسي؟
Are there prognostic baseline or surgical factors associated with the risk of negative outcomes at 1 year following reamed or unreamed intramedullary nailing of open/ closed tibial shaft fractures?
ما هي النتائج المهمة؟
- 1226 patients completed the one year follow-up and were used in the prognostic assessment. 622 patients were treated with reamed intramedullary nails and 604 patients were treated with unreamed intramedullary nails.
- There was an increased risk of negative outcomes in high-energy injuries compared to low energy injuries (OR=1.57 95CI, 1.05 to 2.35) (p=0.03), A similar increase in risk with evident with the use of stainless steel nails compared to titanium (OR-1.52 95CI 1.10 to 2.13) (p<0.01).
- A fracture gap of <1 cm compared to no fracture gap was also associated with a greater risk of negative outcomes (OR= 2.4 95CI, 1.47 to 3.94) (p<0.001), and finally full postoperative weight bearing compared to partial postoperative weight bearing was also associated with a greater risk of negative outcomes (OR=1.63 95CI 1.00 to 2.64) (p<0.048)
- The increased risk associated with full postoperative weight bearing and nail material was attributed to the autodynamization component of the composite score for negative outcomes. Autodynamization rate was 12.8 percent for full weight bearing versus 3.9 percent for partial/non-weight bearing. Autodynamization rate was 2.3 percent with titanium and 10.1 percent with stainless steel.
- Open fracture increased the risk of a negative outcome only for patients who had reamed nailing (OR=3.26 95CI 2.01 to 5.28). Patients who had primary closure or delayed primary closure had a decrease risk of an event compared to those requiring additional soft-tissue reconstruction. (OR=0.18; 95CI, 0.09 to 0.35, and OR= 0.29 CI 0.14 to 0.62 respectively)
- Reamed nailing had a decreased risk of negative outcomes than unreamed for patients with closed fractures (OR=0.60 95CI 0.40 to 0.92) (p=0.02). This relationship was no longer significant with the removal of autodynamization from the composite.
ما الذي يجب أن أتذكره أكثر؟
The multivariable analysis identified a number of prognostic factors for negative events during the treatment of open and closed tibial shaft fractures. An increased risk of a negative event was found for high energy fractures, stainless steel nails vs titanium nails, fracture gaps, full postoperative weight bearing, and open fractures treated with reamed nailing.
كيف سيؤثر ذلك على رعاية مرضاي؟
The findings from this study have identified a number of prognostic factors that may indicate an increased risk of a negative event during treatment of tibial fractures. The findings from this study can assist in identifying the best possible treatment option depending on the characteristics of the injury and instrumentation available.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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