Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, Chang Gung University, No 6, West Section, Chia Pu Road, Puzih, Chia-Yi Hsien, 613, Taiwan,
Arch Orthop Trauma Surg. 2014 Jan;134(1):39-45. doi: 10.1007/s00402-013-1884-5. Epub 2013 Nov 21.
Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear.
One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m(2)). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60 ml/min/1.73 m(2)) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared.
In Group 1, 32 complications (32.6%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively).
Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision.
Prognostic studies, Level III.
慢性肾脏病（CKD）影响许多生理系统，包括骨质量、营养和心血管状况。透析患者的股骨颈骨折常伴有频繁的并发症和高死亡率。然而，CKD 对接受内固定治疗的髋部骨折患者的临床结局的影响尚不清楚。
130 例 130 例股骨颈骨折患者行内固定术，分为两组，然后对数据进行分析。第 1 组 98 例（98 髋）肾功能正常（估算肾小球滤过率或 eGFR≥60ml/min/1.73m2）。第 2 组由 32 例（32 髋）无透析的 CKD（eGFR＜60ml/min/1.73m2）患者组成。记录两组患者的临床转归以及早期和晚期并发症。对两组患者进行生存分析，并比较死亡率和并发症发生率。
第 1 组 98 髋中有 32 髋（32.6%）发生 32 例并发症，包括 5 例骨不连和 16 例骨坏死。第 2 组 32 髋中有 24 例（75%）发生 24 例并发症，包括 8 例骨不连和 3 例骨坏死。平均随访时间为 32 个月。总死亡率为 11.5%。两组患者的早期、晚期和总体死亡率无差异。CKD 患者的骨不连发生率更高（OR=5.9，P=0.023）。同时，CKD 和移位骨折模式是翻修手术的独立预测因素（OR=3.0，P=0.032；OR=6.9，P=0.001）。
内固定术是治疗股骨颈骨折的安全有效方法；然而，股骨颈骨折合并 CKD 的患者有更高的骨不连风险和随后的手术翻修风险。
预后研究，三级。
