Toronto Western Hospital, Toronto, Ontario, Canada.
Clin Interv Aging. 2011;6:1-7. doi: 10.2147/CIA.S10204. Epub 2010 Dec 20.
As the world's population ages, hip fractures pose a significant health care problem. Hip fractures in the elderly are associated with impaired mobility, and increased morbidity and mortality. Associated conditions, such as osteoporosis, medical comorbidity, and dementia, pose a significant concern and determine optimal treatment. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. The incidence of hip fractures is bimodal in its distribution. Young adult hip fractures are the result of high energy trauma, and the larger peak seen in the elderly population is secondary to low-energy injuries. The predilection for the site of fracture at the neck of femur falls into two major subgroups. Pertrochanteric fractures occur when the injury is extracapsular and the blood supply to the head of femur is unaffected. The management of this group involves internal fixation through a sliding hip screw device or intramedullary fixation device, both of which have good results. The other group of patients who sustain an intracapsular fracture at the femoral neck are at increased risk of nonunion and osteonecrosis. Recent papers in the literature have shown better functional outcomes with a primary hip replacement over other treatment modalities. This article reviews the current literature and indications for a primary total hip replacement in these patients.
随着世界人口老龄化，髋部骨折成为一个重大的医疗保健问题。老年人髋部骨折与活动能力受损、发病率和死亡率增加有关。相关疾病，如骨质疏松症、合并症和痴呆症，令人担忧，并决定了最佳治疗方案。目前，一年死亡率范围为 14%至 36%，这些患者的护理代表了一个重大的全球经济负担。髋部骨折的发生率呈双峰分布。年轻成人髋部骨折是高能创伤的结果，而老年人中更大的峰值则是由于低能量损伤引起的。股骨颈骨折的部位偏好分为两个主要亚组。当损伤位于关节囊外且股骨头部的血液供应不受影响时，发生转子间骨折。该组患者的治疗方法包括通过滑动髋螺钉装置或髓内固定装置进行内固定，这两种方法都有良好的效果。另一组股骨颈囊内骨折的患者发生骨不连和骨坏死的风险增加。文献中的最新研究表明，与其他治疗方法相比，初次髋关节置换术可获得更好的功能结果。本文回顾了目前的文献和在这些患者中进行初次全髋关节置换术的适应证。
