Warschawski Yaniv, Sharfman Zachary T, Berger Omri, Steinberg Ely L, Amar Eyal, Snir Nimrod
Division of Orthopedic Surgery, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Orthopedic Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
Injury. 2016 Feb;47(2):424-7. doi: 10.1016/j.injury.2015.10.054. Epub 2015 Oct 30.
Intracapsular hip fractures (ICHF) are a common cause of morbidity and mortality and pose a great economic burden on the health care systems. Appropriate surgical treatment requires balancing optimal outcomes with the cost of treatment to the health care system. While in elderly patients with displaced ICHF arthroplasty became the standard of care, the internal fixation method for conserving the femoral head in younger patients or in nondisplaced ICHF is still in debate. We compared a dynamic locking plate with the standard cancellous cannulated screws (CCS) for treatment of nondisplaced ICHF.
All patients treated with internal fixation for nondisplaced ICHF between July 2009 and December 2012 at our level one trauma center were included in this study. Patients treated with Targon FN (Aesculap) implants and CCS (Synthes) were compared. Charts were reviewed for demographics, intraoperative data and peri/post operative complications retrospectively. Radiographical analysis, pain (VAS), quality of life (SF12) and function (MHHS) data were prospectively gathered.
One hundred and fifteen non-displaced ICHFs were treated with internal fixation, 81 with CCS and 34 with Targon FN implant; the mean follow-up was 19 and 28 months, respectively. Group fracture characteristics (Garden/Powel classification), and demographics, excluding age, were not significantly different. Post-operative revision rates of the Targon FN and CCS groups, perioperative complications were not statistically different (p>0.05). Quality of life (SF-12), function (Modified Harris Hip Score) and Visual Analogue Scale (VAS) pain scores were not statistical different.
Complication rates and clinical outcomes for the treatment of nondisplaced ICHF with Targon FN and SCC showed no significant differences. Based on this evidence in consideration of the substantial cost differential between the Targon FN and SCC we suggest SCC for treatment of nondisplaced ICHF.
III.
囊内髋部骨折（ICHF）是发病和死亡的常见原因，给医疗保健系统带来巨大经济负担。适当的手术治疗需要在优化治疗效果与医疗保健系统的治疗成本之间取得平衡。虽然在老年移位型ICHF患者中，关节置换术已成为标准治疗方法，但对于年轻患者或非移位型ICHF保留股骨头的内固定方法仍存在争议。我们比较了动力锁定钢板与标准的松质骨空心螺钉（CCS）治疗非移位型ICHF的效果。
本研究纳入了2009年7月至2012年12月在我们的一级创伤中心接受非移位型ICHF内固定治疗的所有患者。比较了使用Targon FN（蛇牌）植入物和CCS（辛迪思）治疗的患者。回顾病历以获取人口统计学、术中数据以及围手术期/术后并发症的回顾性信息。前瞻性收集影像学分析、疼痛（视觉模拟评分法[VAS]）、生活质量（SF-12）和功能（改良Harris髋关节评分[MHHS]）数据。
115例非移位型ICHF接受了内固定治疗，81例使用CCS，34例使用Targon FN植入物；平均随访时间分别为19个月和28个月。两组骨折特征（Garden/Powel分类）以及除年龄外的人口统计学特征无显著差异。Targon FN组和CCS组的术后翻修率、围手术期并发症无统计学差异（p>0.05）。生活质量（SF-12）、功能（改良Harris髋关节评分）和视觉模拟评分法（VAS）疼痛评分无统计学差异。
使用Targon FN和松质骨空心螺钉（SCC）治疗非移位型ICHF的并发症发生率和临床结果无显著差异。基于这一证据，并考虑到Targon FN和SCC之间的巨大成本差异，我们建议使用SCC治疗非移位型ICHF。
III级
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