Skinner P, Riley D, Ellery J, Beaumont A, Coumine R, Shafighian B
Orthopaedic Department, Mayday Hospital, Croydon, UK.
Injury. 1989 Sep;20(5):291-3. doi: 10.1016/0020-1383(89)90171-x.
In a prospective trial of 278 patients aged over 65 years, treatment of displaced subcapital fractures was randomly allocated to closed reduction and internal fixation with a sliding compression screwplate, Moore hemiarthroplasty, or total hip treatment with a Howse semicaptive prosthesis. One year after operation there was little difference between the three groups in mortality (25 per cent) or general complications. The revision rate within the first year was highest for internal fixation (25 per cent), but many of the replacements also required a further anaesthetic for reduction of a dislocation (Moore, 11 per cent; Howse 12.5 per cent). Total hip replacement resulted in the least pain and most mobility at 1 year, while hemiarthroplasty was worst in these respects. We conclude that internal fixation and particularly primary total hip replacement should be given serious consideration in the management of the elderly patient with a displaced subcapital fracture.
在一项针对278名65岁以上患者的前瞻性试验中，对于移位的股骨颈骨折的治疗被随机分配为采用滑动加压螺钉钢板进行闭合复位内固定、Moore半关节成形术或使用Howse半限制型假体进行全髋关节置换。术后一年，三组在死亡率（25%）或一般并发症方面几乎没有差异。内固定在第一年的翻修率最高（25%），但许多置换手术也需要再次麻醉以复位脱位（Moore型，11%；Howse型，12.5%）。全髋关节置换在术后1年时疼痛最少且活动度最大，而半关节成形术在这些方面最差。我们得出结论，在老年移位性股骨颈骨折患者的治疗中，应认真考虑内固定，尤其是初次全髋关节置换。
