Müller Franz, Galler Michael, Zellner Michael, Bäuml Christian, Füchtmeier Bernd
Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
Clinic for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany.
Injury. 2015 Oct;46(10):1983-7. doi: 10.1016/j.injury.2015.06.048. Epub 2015 Jul 13.
To date, there is a lack of valid data with larger populations of patients in their 10th decade of life in the analyses of proximal femoral fractures.
The inclusion criteria focused on all proximal femoral fractures in patients 90-99 years of age who underwent surgical treatment between 2009 and 2012. After a period of at least 2 years post-surgery, a retrospective collection of empiric data, including the survival time and surgical revision rate, was performed. Missing data were collected per telephone interview.
A total of 121 proximal femoral fractures in 117 patients in their 10th decade of life were treated. The mean age was 92.3 years. 61 fractures of the femoral neck received hemi- or total hip arthroplasty, while 60 pertrochanteric or subtrochanteric fractures were treated by osteosynthesis using proximal femoral nail (PFN) or dynamic hip screw (DHS). At the time of follow-up, 83/117 patients (71%) were already deceased. The mortality after 30 days, 6 months, 1 year and 2 years was 16%, 37%, and 43%, and 55%, respectively. A total of 22 surgical revisions (19%) were performed: 10 due to early infections, 8 due to haematomas, and 4 due to implant failures with a "cut out" of the femoral neck screw exclusively in DHS. The duration of surgery (with regard to surgical revision) and ASA classification (with regard to survival rate) were significant influence factors. Contralateral proximal femoral fractures were identified in 24/117 patients (20%), irrespective of study period.
The proximal femoral fractures in the 10th decade of life are associated with high postoperative mortality within the first 6 months. Surgical revision due to complications did not result in a statistically significant reduction of the survival time. From the osteosynthetic perspective, the DHS was associated with a significantly higher "cut-out" rate compared to PFN procedure. With regard to the alloarthoplasty, there were no significant differences observed between hemi- and total hip arthroplasty. A contralateral femoral fractures was observed in 20% of the total study population, but peri-implant or periprosthetic femoral fractures have not been observed in any of the cases thus far.
迄今为止，在近端股骨骨折分析中，缺乏针对大量100岁左右患者的有效数据。
纳入标准聚焦于2009年至2012年间接受手术治疗的90至99岁患者的所有近端股骨骨折。术后至少2年，进行经验数据的回顾性收集，包括生存时间和手术翻修率。通过电话访谈收集缺失数据。
共治疗了117例100岁左右患者的121例近端股骨骨折。平均年龄为92.3岁。61例股骨颈骨折接受了半髋关节置换术或全髋关节置换术，而60例转子间或转子下骨折采用股骨近端髓内钉（PFN）或动力髋螺钉（DHS）进行接骨板固定治疗。随访时，83/117例患者（71%）已经死亡。术后30天、6个月、1年和2年的死亡率分别为16%、37%、43%和55%。共进行了22次手术翻修（19%）：10次因早期感染，8次因血肿，4次因植入物失败，仅在DHS中出现股骨颈螺钉“穿出”。手术时间（与手术翻修相关）和ASA分级（与生存率相关）是显著的影响因素。在24/117例患者（20%）中发现了对侧近端股骨骨折，与研究时间段无关。
100岁左右患者的近端股骨骨折在术后6个月内与高死亡率相关。因并发症进行的手术翻修并未使生存时间在统计学上显著缩短。从接骨板固定角度来看DHS与PFN手术相比，“穿出”率显著更高。关于关节置换术，半髋关节置换术和全髋关节置换术之间未观察到显著差异。在整个研究人群中，20%观察到对侧股骨骨折，但迄今为止，在任何病例中均未观察到植入物周围或假体周围股骨骨折。
