Healy William L, Iorio Richard
Department of Orthopaedic Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
Clin Orthop Relat Res. 2004 Dec(429):43-8.
Although internal fixation is recommended for most nondisplaced fractures of the femoral neck, the optimal treatment for displaced fractures of the femoral neck is controversial. Options for operative treatment of displaced fractures of the femoral neck include: reduction and internal fixation; unipolar hemiarthroplasty; bipolar hemiarthroplasty; and total hip arthroplasty. One hundred eighty-six displaced fractures of the femoral neck in elderly patients were treated surgically with internal fixation (in 120 patients), hemiarthroplasty (in 43 patients), and total hip arthroplasty (in 23 patients). One hundred twenty patients with displaced fractures treated with internal fixation were compared with 66 patients with displaced fractures treated with arthroplasty. Criteria for comparison were reoperation, mortality, hospital discharge disposition, functional outcome, living status, and cost effectiveness. There was no difference in rates of reoperation or mortality, but arthroplasty produced a longer interval to reoperation or death. Arthroplasty was associated with more independent living, and arthroplasty was more cost-effective than internal fixation. Total hip arthroplasty was the best treatment for displaced fractures of the femoral neck in elderly patients in this series.
虽然对于大多数无移位的股骨颈骨折推荐采用内固定治疗，但对于移位的股骨颈骨折的最佳治疗方法仍存在争议。股骨颈移位骨折的手术治疗选择包括：复位及内固定；单极半髋关节置换术；双极半髋关节置换术；以及全髋关节置换术。186例老年患者的股骨颈移位骨折接受了手术治疗，其中120例行内固定，43例行半髋关节置换术，23例行全髋关节置换术。将120例接受内固定治疗的移位骨折患者与66例接受关节置换术治疗的移位骨折患者进行比较。比较标准包括再次手术、死亡率、出院情况、功能结果、生活状况和成本效益。再次手术率或死亡率无差异，但关节置换术导致再次手术或死亡的间隔时间更长。关节置换术与更多的独立生活相关，并且关节置换术比内固定更具成本效益。在本系列中，全髋关节置换术是老年患者股骨颈移位骨折的最佳治疗方法。
