Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden.
J Bone Joint Surg Am. 2012 Nov 7;94(21):1921-8. doi: 10.2106/JBJS.K.01615.
Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years.
We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial;all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at three months and at one, two, four, eleven, and seventeen years.
The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95%confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64).The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year.
Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality.
Therapeutic Level I.
短期和中期随访的临床试验表明，对于老年移位型股骨颈骨折患者，全髋关节置换在髋关节功能和二次手术需求方面优于内固定。本研究的目的是比较全髋关节置换与内固定在长达 17 年的长期随访中的结果。
我们在一项单中心、随机对照试验中纳入了 100 名股骨颈骨折患者；所有患者在受伤前均有健康的髋关节。研究组包括 79 名女性和 21 名男性，平均年龄 78 岁（65-90 岁）。将患者随机分为全髋关节置换（关节置换组）（n=43）或内固定（对照组）（n=57）。主要终点是髋关节功能，采用 Harris 髋关节评分进行评估。次要终点包括死亡率、再次手术、步态速度和日常生活活动。在 3 个月和 1、2、4、11 和 17 年进行随访评估。
全髋关节置换组的 Harris 髋关节评分更高，研究期间平均差异为 14.7 分（95%置信区间，9.2-20.1 分；p<0.001[协方差分析]）。两组死亡率无差异。全髋关节置换组有 4 名患者（9%）和内固定组有 22 名患者（39%）进行了主要再手术（相对风险，0.24；95%置信区间，0.09-0.64）。全髋关节置换组总体再手术率为 23%（43 例中的 10 例），内固定组为 53%（57 例中的 30 例）（相对风险，0.44；95%置信区间，0.24-0.80）。与内固定相比，步态速度和日常生活活动的结果在第一年更有利于关节置换组。
在一组健康的老年移位型股骨颈骨折患者中，全髋关节置换在 17 年的时间内提供了更好的髋关节功能，并且显著减少了再手术，而不会增加死亡率。
治疗性 I 级。
