Rogmark C, Leonardsson O
Lund University, Skåne University Hospital, Malmö, Sweden and, Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden.
Blekinge Hospital, SE-371 85 Karlskrona, Sweden.
Bone Joint J. 2016 Mar;98-B(3):291-7. doi: 10.1302/0301-620X.98B3.36515.
This review summarises the evidence for the treatment of displaced fractures of the femoral neck in elderly patients. Results from randomised clinical trials and national register studies are presented when available. The advantages of arthroplasty compared with internal fixation are supported by several studies. A number of studies contribute to the discussions of total hip arthroplasty (THA) versus hemiarthroplasty and unipolar versus bipolar hemiarthroplasty, but no clear-cut evidence-based recommendation can be made. THA may be particularly advantageous for active, lucid patients with a relatively long life expectancy. For patients who are physiologically older, hemiarthoplasty is probably satisfactory, and for the oldest patients with more comorbidities, unipolar implants are considered to be sufficient. If the hospital can support emergency THA surgery in sufficient numbers and quality, there may be few patients who warrant bipolar hemiarthroplasty. The direct lateral approach reduces the risk of dislocation compared with the posterior approach. Cemented implants lower the risk of periprosthetic fracture and its subsequent morbidity and mortality. As the risk of peri-operative death related to bone cement can be reduced by adequate measures, cemented implants are recommended in fracture cases.
There remains a great variation in the surgical management of patients with a hip fracture, and an evidence-based approach should improve the outcomes for this vulnerable patient group.
本综述总结了老年患者股骨颈移位骨折治疗的相关证据。如有随机临床试验和国家登记研究的结果，将予以呈现。多项研究支持关节置换术相较于内固定术的优势。许多研究参与了全髋关节置换术（THA）与半髋关节置换术以及单极与双极半髋关节置换术的讨论，但无法做出明确的基于证据的推荐。THA对于预期寿命相对较长、活跃且神志清醒的患者可能特别有利。对于生理年龄较大的患者，半髋关节置换术可能就足够了，而对于合并症更多的高龄患者，单极植入物被认为是足够的。如果医院能够在数量和质量上支持急诊THA手术，那么需要双极半髋关节置换术的患者可能很少。与后外侧入路相比，直接外侧入路可降低脱位风险。骨水泥型植入物可降低假体周围骨折及其后续发病率和死亡率。由于通过适当措施可降低与骨水泥相关的围手术期死亡风险，因此在骨折病例中推荐使用骨水泥型植入物。
髋部骨折患者的手术治疗仍存在很大差异，基于证据的方法应能改善这一脆弱患者群体的治疗效果。
