Faroug R, Amanat S, Ockendon M, Shah S V, Gregory J J
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
Injury. 2014 Jul;45(7):1076-9. doi: 10.1016/j.injury.2014.02.036. Epub 2014 Mar 12.
There are many negative health consequences associated with alcohol dependency. Fractures of the proximal femur carry significant morbidity and mortality. This study examines the outcomes in patients with alcohol dependency, who sustain a fracture of the proximal femur. Twenty-eight consecutive alcohol dependent patients who suffered a fracture of the proximal femur were identified over a three year period. Data were collected on demographics, co-morbidity, surgical factors, mobility and mortality. The median age of patients was 61 years. The median weekly alcohol intake was 158 units. Thirteen patients sustained an extra-capsular fracture and 15 an intra-capsular proximal femoral fracture. Twenty-two fractures were treated with internal fixation and six with arthroplasty. The overall mortality rate was 29% at a median of 15 months post fracture. The failure rate of intra-capsular fractures fixed with cannulated screws was 56% at a median time of 43 days. All patients had a reduction in mobility compared to their pre-operative function. The reduction in mobility was greatest in patients with intra-capsular fractures treated with cannulated screw fixation. Alcohol dependent patients sustaining a fracture of the proximal femur are significantly younger than non-alcohol dependent patients sustaining the same injury. Despite the younger age at presentation the one year mortality rate of this group was high (29%). The high rate of complications with fracture fixation and high one year mortality suggest that hemiarthroplasty may be the best treatment option for intra-capsular fractures in this patient group.
酒精依赖会带来许多负面的健康后果。股骨近端骨折具有较高的发病率和死亡率。本研究调查了股骨近端骨折的酒精依赖患者的治疗结果。在三年时间里，连续确定了28例股骨近端骨折的酒精依赖患者。收集了有关人口统计学、合并症、手术因素、活动能力和死亡率的数据。患者的中位年龄为61岁。每周酒精摄入量的中位数为158单位。13例为囊外骨折，15例为囊内股骨近端骨折。22例骨折采用内固定治疗，6例采用关节置换术治疗。骨折后中位15个月时的总死亡率为29%。空心螺钉固定囊内骨折的失败率在中位时间43天时为56%。与术前功能相比，所有患者的活动能力均有所下降。采用空心螺钉固定治疗囊内骨折的患者活动能力下降最为明显。股骨近端骨折的酒精依赖患者比遭受同样损伤的非酒精依赖患者明显年轻。尽管就诊时年龄较轻，但该组患者的一年死亡率较高（29%）。骨折固定的高并发症发生率和高一年死亡率表明，半关节置换术可能是该患者组囊内骨折的最佳治疗选择。
