Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
Arch Orthop Trauma Surg. 2014 Jul;134(7):941-6. doi: 10.1007/s00402-014-2003-y. Epub 2014 May 8.
The purpose of the present study was to evaluate the clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in patients aged 65 years and older.
The records of consecutive patients who underwent surgery for undisplaced femoral neck fractures between 1999 and 2011 were retrospectively reviewed. The patients underwent the surgery as early as possible, and allowed early full weight-bearing. The interval between initial injury and surgery, time to admission and operation, operation time, decrease in hemoglobin, the postoperative day starting to walk, postoperative walking status, and the incidence of any secondary procedures were evaluated. The average patient age was 77.5 years and the average duration of postoperative follow-up was 46.8 months. The patients were divided to two groups to determine the effect of early operation: the early operation group within 24 h on admission, and the late operation group done 24 h after admission.
Eighty-six percent of surgeries were performed within 48 h of admission. The average operation time was 46 min (range 20-95 min). Transfusions were performed in 6.9 % (4/58) of patients. The mortality rate was 6.9 %, and the rate of complications was 9.3 % (5/54): four cases of avascular necrosis (AVN) and one case of fixation failure. The rate of secondary procedures was 7.4 % (4/54). Seventy-two percent (39/54) of patients recovered their postoperative walking ability to pre-injury levels.
This study demonstrated that early internal fixation of undisplaced femoral neck fractures in elderly patients produced satisfactory clinical outcomes.
本研究旨在评估对 65 岁及以上无移位股骨颈骨折患者进行早期内固定和早期完全负重的临床疗效。
回顾性分析了 1999 年至 2011 年连续接受手术治疗的无移位股骨颈骨折患者的病历。患者尽早接受手术治疗，并允许早期完全负重。评估了从初次受伤到手术的时间间隔、入院到手术的时间间隔、手术时间、血红蛋白下降量、术后开始行走的时间、术后行走状况以及任何二次手术的发生率。平均患者年龄为 77.5 岁，术后随访平均时间为 46.8 个月。将患者分为两组以确定早期手术的效果：入院后 24 小时内的早期手术组和入院后 24 小时后进行的晚期手术组。
86%的手术在入院后 48 小时内进行。平均手术时间为 46 分钟（范围 20-95 分钟）。6.9%（4/58）的患者需要输血。死亡率为 6.9%，并发症发生率为 9.3%（5/54）：4 例发生股骨头坏死（AVN），1 例发生固定失败。二次手术率为 7.4%（4/54）。72%（39/54）的患者术后行走能力恢复到受伤前的水平。
本研究表明，对老年无移位股骨颈骨折患者进行早期内固定可获得满意的临床疗效。
