Grosso Matthew G, Danoff Jonathan R, Padgett Douglas E, Iorio Richard, Macaulay William B
Center for Hip & Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York.
Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2016 May;31(5):1040-6. doi: 10.1016/j.arth.2015.11.029. Epub 2015 Dec 2.
Significant variability exists across orthopedic surgeons in the management of the displaced femoral neck fracture in the elderly patient (>75 years old). These patients tend to be less healthy, have inferior bone quality, and gait instability leading to increased risk of periprosthetic fracture, compromised implant fixation, dislocation, and need for revision. The surgeon's goals should be to restore mobility while eliminating pain and need for reoperation.
In this review article, we examine the best available evidence in the literature to determine which strategy achieves optimal outcomes. We examine outcome studies comparing use of hemiarthroplasty and total hip arthroplasty, unipolar and bipolar hemiarthroplasty, and cemented vs cementless fixation of femoral stems.
For the active, healthy, and lucid patient, or one who has preexisting groin pain, who sustains a displaced femoral neck fracture, the literature supports a total hip arthroplasty. Patients sustaining a displaced femoral neck fracture and who are less active, have decreased bone mass, and are at increased risk of falls would benefit most from a device that optimally balances the need for revision surgery, restores ambulation, and eliminates pain. Thus, the current evidence favors cemented, unipolar hemiarthroplasty for the dependent osteopenic elderly patient with a displaced femoral neck fracture.
在老年患者（>75岁）移位型股骨颈骨折的治疗方面，骨科医生的处理方式存在显著差异。这些患者往往健康状况较差、骨质欠佳且步态不稳，导致假体周围骨折风险增加、植入物固定不佳、脱位以及需要翻修手术。外科医生的目标应该是恢复活动能力，同时消除疼痛并避免再次手术。
在这篇综述文章中，我们研究了文献中现有的最佳证据，以确定哪种策略能取得最佳结果。我们研究了比较半髋关节置换术和全髋关节置换术、单极和双极半髋关节置换术以及股骨柄骨水泥固定与非骨水泥固定的疗效研究。
对于活跃、健康且神志清醒或者已有腹股沟疼痛的患者，若发生移位型股骨颈骨折，文献支持采用全髋关节置换术。对于移位型股骨颈骨折且活动较少、骨量减少以及跌倒风险增加的患者，最能受益于一种能最佳平衡翻修手术需求、恢复行走能力并消除疼痛的器械。因此，目前的证据支持为患有移位型股骨颈骨折的依赖型骨质疏松老年患者采用骨水泥固定的单极半髋关节置换术。
