内固定螺钉与双极股骨头置换术治疗老年移位股骨颈骨折的比较。

Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients.

机构信息

Department of Orthopaedic Surgery, Haukeland University Hospital, 5021 Bergen, Norway.

出版信息

J Bone Joint Surg Am. 2010 Mar;92(3):619-28. doi: 10.2106/JBJS.H.01750.

DOI:10.2106/JBJS.H.01750

PMID:20194320

Abstract

BACKGROUND

Internal fixation and arthroplasty are the two main options for the treatment of displaced femoral neck fractures in the elderly. The optimal treatment remains controversial. Using data from the Norwegian Hip Fracture Register, we compared the results of hemiarthroplasty and internal screw fixation in displaced femoral neck fractures.

METHODS

Data from 4335 patients over seventy years of age who had internal fixation (1823 patients) or hemiarthroplasty (2512 patients) to treat a displaced femoral neck fracture were compared at a minimum follow-up interval of twelve months. One-year mortality, the number of reoperations, and patient self-assessment of pain, satisfaction, and quality of life at four and twelve months were analyzed. Subanalyses of patients with cognitive impairment and reduced walking ability were done.

RESULTS

In the arthroplasty group, only contemporary bipolar prostheses were used and uncemented prostheses with modern stems and hydroxyapatite coating accounted for 20.8% (522) of the implants. There were no differences in one-year mortality (27% in the osteosynthesis group and 25% in the arthroplasty group; p = 0.76). There were 412 reoperations (22.6%) performed in the osteosynthesis group and seventy-two (2.9%) in the hemiarthroplasty group during the follow-up period. After twelve months, the osteosynthesis group reported more pain (mean score, 29.9 compared with 19.2), higher dissatisfaction with the operation result (mean score, 38.9 compared with 25.7), and a lower quality of life (mean score, 0.51 compared with 0.60) than the arthroplasty group. All differences were significant (p < 0.001). For patients with cognitive impairment, hemiarthroplasty provided a better functional outcome (less pain, higher satisfaction with the result of the operation, and higher quality of life as measured on the EuroQol visual analog scale) at twelve months (p < 0.05).

CONCLUSIONS

Displaced femoral neck fractures in the elderly should be treated with hemiarthroplasty.

摘要

背景

对于老年移位股骨颈骨折，内固定和关节置换是两种主要的治疗选择。最佳治疗方法仍存在争议。我们使用挪威髋关节骨折登记处的数据，比较了半髋关节置换术和内固定螺钉治疗移位股骨颈骨折的结果。

方法

对接受内固定（1823 例）或半髋关节置换术（2512 例）治疗移位股骨颈骨折的 4335 例 70 岁以上患者，在至少 12 个月的随访期内进行比较。分析了 1 年死亡率、再次手术的数量以及 4 个月和 12 个月时患者对疼痛、满意度和生活质量的自我评估。对认知障碍和行走能力降低的患者进行了亚组分析。

结果

在关节置换组中，仅使用了当代双极假体，而未使用现代柄和羟基磷灰石涂层的非骨水泥假体占植入物的 20.8%（522 例）。内固定组和关节置换组的 1 年死亡率无差异（分别为 27%和 25%；p=0.76）。在随访期间，内固定组有 412 例（22.6%）进行了再次手术，关节置换组有 72 例（2.9%）。12 个月后，内固定组报告疼痛更严重（平均评分 29.9 分，19.2 分；p<0.001），对手术结果的满意度较低（平均评分 38.9 分，25.7 分；p<0.001），生活质量评分较低（平均评分 0.51 分，0.60 分；p<0.001）。所有差异均有统计学意义。对于认知障碍患者，12 个月时半髋关节置换术提供了更好的功能结局（疼痛较轻，对手术结果的满意度较高，EuroQol 视觉模拟量表评分较高）（p<0.05）。