Xu Meng, Zhang Lihai, Mao Zhi, Wang Hao, Chen Hua, Guo Yizhu, Tao Sheng, Zhang Qun, Liang Xiangdang, Tang Peifu
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing 100853, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Dec;24(12):1419-23.
To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods.
Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n = 31), hemiarthroplasty (HA group, n = 37), and total hip arthroplasty (THA group, n = 40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbling (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbling (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbling (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P > 0.05).
There were significant differences in operation time and blood loss among 3 groups (P < 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative complications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative complications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative complication, late postoperative complication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P < 0.05), but there was no significant difference between HA group and THA group (P > 0.05). The mortality rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P > 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P < 0.05).
According to patient's age, life expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
比较内固定、半髋关节置换术和全髋关节置换术治疗老年移位型股骨颈骨折的疗效，为治疗方法的选择提供依据。
2005年5月至2008年4月，108例老年移位型股骨颈骨折患者接受了加压螺钉内固定治疗（IF组，n = 31）、半髋关节置换术（HA组，n = 37）和全髋关节置换术（THA组，n = 40）。IF组中，男性8例，女性23例，平均年龄73岁（范围65 - 80岁）；骨折由跌倒（25例）和交通事故（6例）引起，其中Garden III型17例，Garden IV型14例；受伤至手术时间为8小时至13天，平均4.2天。HA组中，男性10例，女性27例，平均年龄74岁（范围65 - 80岁）；骨折由跌倒（29例）和交通事故（8例）引起，其中Garden III型21例，Garden IV型16例；受伤至手术时间为1至14天，平均4.4天。THA组中，男性11例，女性29例，平均年龄73岁（范围66 - 80岁）；骨折由跌倒（32例）和交通事故（8例）引起，其中Garden III型23例，Garden IV型17例；受伤至手术时间为2至14天，平均5.6天。三组一般资料比较差异无统计学意义（P > = 0.05）。
三组手术时间和出血量比较差异有统计学意义（P < 0.05），IF组均少于其他两组。所有患者均随访1年4个月至2年3个月，平均1年8个月。IF组、HA组和THA组术后早期并发症发生率分别为19.4%（6/31）、8.1%（3/37）和7.5%（3/40）；术后晚期并发症发生率分别为29.0%（9/31）、13.5%（5/37）和7.5%（3/40）；再次手术率分别为29.0%（9/31）、10.8%（4/37）和5.0%（2/40）。IF组术后早期并发症、晚期并发症及再次手术率均显著高于HA组和THA组（P < 0.05），但HA组与THA组比较差异无统计学意义（P > 0.05）。IF组、HA组和THA组死亡率分别为16.1%（5/31））、13.5%（5/37）和15.0%（6/40），差异无统计学意义（P > 0.05）。根据Harris髋关节评分，IF组、HA组和THA组优良率分别为65.4%（17/26）、81.3%（26/32）和85.3%（（29/34），三组比较差异有统计学意义（P < 0.05）。
根据患者年龄、预期寿命和一般状况，THA是治疗65 - 80岁老年移位型股骨颈骨折患者的合理选择。
