Haentjens P, Autier Ph, Barette M, Boonen S
Department of Orthopaedics and Traumatology, Academisch Ziekenhuis V.U.B., Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
Injury. 2005 Jul;36(7):842-50. doi: 10.1016/j.injury.2005.02.002. Epub 2005 Apr 7.
To explore potential predictors of functional outcome one year after the injury in elderly women who sustained a displaced intracapsular hip fracture and who were treated with internal fixation, hemiarthroplasty, or total hip arthroplasty.
Eighty-four women aged > or =50 years were enrolled on a consecutive basis in this one-year prospective cohort study reflecting standard day-to-day clinical practice. The main outcome measure was the rapid disability rating scale version-2 (RDRS-2) applied at hospital discharge and one year later.
At hospital discharge, the total hip arthroplasty group was younger and had a better functional status than the internal fixation or hemiarthroplasty groups. One year later, the best function was still observed in the total arthroplasty group, but the differences were small and failed to achieve the level of statistical significance. During that one-year period, walking ability or mobility did not change significantly after total hip arthroplasty, but a significant proportion of the women developed cognitive impairment, including mental confusion, uncooperativeness, and depression. Overall, the most significant predictors of poor functional status one year after fracture were increasing age, living in an institution at time of injury, and poor functional status at discharge.
In elderly women with a displaced intracapsular hip fracture, total hip arthroplasty is associated with a functional benefit within the first months after surgery. However, the extent to which this functional benefit is maintained over time, is less clear. These results support the need for randomised studies to quantify the extent to which, in elderly women, the early functional benefit of total hip arthroplasty is maintained in the long run or compromised by progressive cognitive impairment and other negative determinants of functional outcome.
探讨接受内固定、半髋关节置换术或全髋关节置换术治疗的老年女性囊内移位型髋部骨折伤后一年功能转归的潜在预测因素。
本为期一年的前瞻性队列研究连续纳入84名年龄≥50岁的女性，反映日常临床实践标准。主要结局指标为出院时及伤后一年应用的快速残疾评定量表第2版（RDRS - 2）。
出院时，全髋关节置换术组比内固定组或半髋关节置换术组年龄更小，功能状态更好。一年后，全关节置换术组仍观察到最佳功能，但差异较小且未达到统计学显著水平。在这一年期间，全髋关节置换术后步行能力或活动能力没有显著变化，但相当一部分女性出现了认知障碍，包括精神错乱、不合作和抑郁。总体而言，骨折后一年功能状态不佳的最显著预测因素是年龄增加、受伤时住在养老院以及出院时功能状态不佳。
在老年女性囊内移位型髋部骨折患者中，全髋关节置换术在术后最初几个月与功能改善相关。然而，这种功能改善随时间持续的程度尚不清楚。这些结果支持需要进行随机研究，以量化在老年女性中，全髋关节置换术的早期功能改善在长期内得以维持的程度，或因进行性认知障碍及其他功能转归的负面决定因素而受到损害的程度。
