Liu Yue-Ju, Xu Bin, Li Zhi-Yong, Zhang Qi, Zhang Ying-Ze
Department of Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Orthopedics. 2012 Feb 17;35(2):e137-43. doi: 10.3928/01477447-20120123-09.
Surgical decision making for femoral neck fractures is currently based on factors such as patient age, fracture type, and medical condition, lacking a quantitative standard. The treatment protocol based on such qualitative assessment has poor operability, greatly affected by the surgeon's subjective factors. As a result, a quantitative score system (QSS) focusing on 5 factors--age, fracture type, bone mineral density, activities of daily living, and medical comorbidities--with a total score of 25 is designed to deal with adult femoral neck fractures. The higher the score, the worse the patient's physiological condition. According to our clinical experience, patients with 1 to 11 points should be treated with internal fixation; patients with 12 to 17 points with total hip arthroplasty (THA), and patients with 18 to 22 points with hemiarthroplasty. Patients with 22 to 25 points should be treated with internal fixation due to the high surgical risk of arthroplasty caused by poor physiological condition. Three hundred seventy-five adult femoral neck fractures were treated on the basis of QSS for this 2-year prospective study. Of these, 242 were treated with low-score internal fixation, 60 with THA, 55 with hemiarthroplasty, and 18 with high-score internal fixation. The revision rates 2 years postoperatively in the low-score internal fixation, THA, and hemiarthroplasty groups were 15.3%, 5.0%, and 5.5%, respectively, which were lower than those from a meta-analysis (internal fixation, 35%; THA, 16%). This QSS helps surgical decision making regarding the treatment choice for adult patients with femoral neck fractures, and good results in preliminary clinical practice have been achieved.
目前，股骨颈骨折的手术决策基于患者年龄、骨折类型和身体状况等因素，缺乏定量标准。基于这种定性评估的治疗方案可操作性差，受外科医生主观因素影响很大。因此，设计了一种关注年龄、骨折类型、骨密度、日常生活活动能力和内科合并症这5个因素的定量评分系统（QSS），总分25分，用于处理成人股骨颈骨折。分数越高，患者的生理状况越差。根据我们的临床经验，1至11分的患者应采用内固定治疗；12至17分的患者采用全髋关节置换术（THA），18至22分的患者采用半髋关节置换术。22至25分的患者由于生理状况差导致关节置换手术风险高，应采用内固定治疗。在这项为期2年的前瞻性研究中，基于QSS对375例成人股骨颈骨折进行了治疗。其中，242例采用低分内固定治疗，60例采用THA治疗，55例采用半髋关节置换术治疗，18例采用高分内固定治疗。低分内固定组、THA组和半髋关节置换术组术后2年的翻修率分别为15.3%、5.0%和5.5%，低于荟萃分析中的翻修率（内固定，35%；THA，16%）。这种QSS有助于对成人股骨颈骨折患者的治疗选择进行手术决策，并且在初步临床实践中取得了良好效果。
