Department of Orthopaedics and Traumatology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Turkey.
Balkan Med J. 2013 Dec;30(4):400-5. doi: 10.5152/balkanmedj.2013.8571. Epub 2013 Dec 1.
The choice of prosthesis in hemiarthroplasty is controversial for geriatric patients after femoral neck fracture. We hypothesised that selection criteria for unipolar or bipolar prostheses could be constructed based on factors affecting mortality.
THE AIMS OF THIS RETROSPECTIVE STUDY WERE: (1) to determine the factors affecting mortality of femoral neck fracture patients ≥65 years of age; (2) to compare patient mortality rates, radiological findings, and functional outcomes according to prosthesis type (unipolar or bipolar); and (3) to evaluate the persistence of inner bearing mobility of bipolar prostheses.
Retrospective comparative study.
In total, 144 patients operated for hemiarthroplasty and aged ≥65 were included. We classified the patients into either unipolar or bipolar prosthesis groups. To reveal factors that affected mortality, age, sex, delay in surgery, and American Society of Anesthesiologists score were obtained from folders. Barthel Daily Living, Harris hip, and acetabular erosion scores were calculated and bipolar head movement was analysed for live patients.
One-year mortality was 31.94%. Age ≥75 (p=0.029), male sex (p=0.048), and delay in surgery ≥6 (p=0.004) were the patient characteristics that were related to increased mortality. There were no significant differences in sex, age, American Society of Anesthesiologists score, delay in surgery, mortality, or Barthel, Harris, acetabulum scores between the two groups. Twenty patients from each group were admitted for last follow-up. Bipolar head movement was preserved for 33.3% of patients. They were inactive patients with low Barthel and Harris scores.
Although bipolar head movement was preserved in inactive patients, we suppose that this conferred no advantage to these patients, who could hardly walk. In this study, male patients, those aged ≥75 years, and those operated at ≥6 days had an increased risk of mortality. Also, although not significant in multivariate analysis, high American Society of Anesthesiologists score (≥3) was related to increased mortality. Considering that one of three patients died during the first postoperative year, we think that these patients should be operated as soon as possible, and expensive bipolar prostheses must be used selectively in regard to patient characteristics.
对于股骨颈骨折的老年患者，半髋关节置换术中假体的选择存在争议。我们假设可以根据影响死亡率的因素来构建单极或双极假体的选择标准。
本回顾性研究的目的是：（1）确定影响≥65 岁股骨颈骨折患者死亡率的因素；（2）比较根据假体类型（单极或双极）的患者死亡率、影像学发现和功能结果；（3）评估双极假体内部承窝移动的持久性。
回顾性比较研究。
共纳入 144 例接受半髋关节置换术且年龄≥65 岁的患者。我们将患者分为单极或双极假体组。为了揭示影响死亡率的因素，从文件夹中获取年龄、性别、手术延迟和美国麻醉师协会评分。计算巴氏日常生活活动、Harris 髋关节和髋臼侵蚀评分，并分析存活患者的双极头移动。
一年死亡率为 31.94%。年龄≥75 岁（p=0.029）、男性（p=0.048）和手术延迟≥6 天（p=0.004）是与死亡率增加相关的患者特征。两组间在性别、年龄、美国麻醉师协会评分、手术延迟、死亡率或巴氏、Harris、髋臼评分方面无显著差异。每组各有 20 例患者接受了最后一次随访。双极头的运动在 33.3%的患者中得到了保留。这些是活动能力差、巴氏和 Harris 评分低的患者。
尽管双极头的运动在不活动的患者中得到了保留，但我们认为这对几乎不能行走的这些患者没有优势。在这项研究中，男性患者、年龄≥75 岁的患者和手术时间≥6 天的患者的死亡率增加。此外，尽管在多变量分析中不显著，但美国麻醉师协会评分较高（≥3）与死亡率增加有关。考虑到三分之一的患者在术后第一年死亡，我们认为这些患者应尽快手术，并且必须根据患者特征有选择地使用昂贵的双极假体。
