Rogmark Cecilia, Carlsson Ake, Johnell Olof, Sembo Ingemar
Department of Orthopaedics, Malmö University Hospital, SE-205 02 Malmö, Sweden.
Acta Orthop Scand. 2003 Jun;74(3):293-8. doi: 10.1080/00016470310014210.
We included in a prospective, randomized study 68 patients aged 70 years or older, with displaced cervical hip fractures. The patients were randomized to internal fixation with hook-pins (36) or primary arthroplasty (32) (total or hemiarthroplasty due to their prefracture status) and followed for 2 years. Patients with rheumatoid arthritis, mental confusion and/or residence in an institution were excluded. The postoperative stay in hospital, rehabilitation wards or nursing homes were recorded as well as complications and the costs of surgery. The aim of this study was to compare the accumulated costs of each method, during the first 2 years after the fracture. In the internal fixation group, 15/36 were considered failures, as compared to 1/32 in the arthroplasty group. As regards primary treatment of the fracture, the durations of surgery and hospital stay were shorter after internal fixation, but the total need for hospitalization/institutionalization was somewhat longer in these patients. The mean 2-year cost for a patient with internal fixation was USD 21,000 and of one with primary arthroplasty USD 15,000. We conclude that primary arthroplasty is a cost-efficient treatment. Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck.
我们将68例70岁及以上的移位型颈椎髋部骨折患者纳入一项前瞻性随机研究。患者被随机分为钩钉内固定组（36例）或一期关节置换组（32例）（根据骨折前状况进行全关节置换或半关节置换），并随访2年。排除类风湿关节炎、精神错乱和/或住在养老院的患者。记录术后住院时间、康复病房或疗养院的时间以及并发症和手术费用。本研究的目的是比较骨折后前两年每种方法的累积费用。内固定组36例中有15例被认为治疗失败，而关节置换组32例中只有1例失败。在骨折的初始治疗方面，内固定术后手术时间和住院时间较短，但这些患者总的住院/机构护理时间略长。内固定患者的平均2年费用为21,000美元，一期关节置换患者为15,000美元。我们得出结论，一期关节置换是一种具有成本效益的治疗方法。考虑到内固定后失败率非常高，会给这些患者带来更多痛苦，一期关节置换是股骨颈移位骨折的最佳治疗方法。
