老年患者不稳定型股骨粗隆间骨折与移位型股骨颈骨折行非骨水泥双极半髋关节置换术的比较：80例匹配患者的对比研究
Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients; a comparison of 80 matched patients.
作者信息
Chang J-D, Kim I-S, Lee S-S, Yoo J-H, Hwang J-H
机构信息
Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40 Seokwoo-dong, Hwasung 445-907, Republic of Korea.
Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon 200-704, Republic of Korea.
出版信息
Orthop Traumatol Surg Res. 2016 Oct;102(6):695-9. doi: 10.1016/j.otsr.2016.04.007. Epub 2016 May 24.
BACKGROUND
While hemiarthroplasty (HA) is considered the treatment of choice for displaced femoral neck (FN) fractures in elderly patients, HA has been partly performed as an alternative treatment option for unstable intertrochanteric (IT) fractures. However, there is a paucity of data regarding the risk and availability of HA for unstable IT fractures compared to HA for displaced FN fractures in elderly patients. Therefore, we performed this case-control study to determine whether HA for unstable IT fractures provides clinical results and survival comparable to HA for displaced FN fractures in elderly patients.
HYPOTHESIS
HA for unstable IT fractures in elderly patients provides clinical results and 1-year survival comparable to HA for displaced FN fractures in the same aging group.
MATERIALS AND METHODS
We identified 80 patients aged 75years or older, who underwent cementless bipolar HA for unstable IT fracture (AO/OTA type 31-A2.2/3 and A3.3). Their clinical results and 1-year survival were compared to the matched control group of 80 patients with displaced FN fractures (Garden type 3 and 4) treated with the same procedure. Perioperative results, postoperative complications, and 1-year survival were investigated between the two groups. Functional outcome was assessed by walking status and Harris hip score (HHS) 6months after surgery.
RESULTS
Operating time was significantly longer in the IT group than the FN group (97.3min [50 to 255] vs. 79.3min [40 to 175], P=0.016). However, the two groups did not significantly differ regarding perioperative results, such as total blood loss, transfusion, intraoperative fracture, length of hospital stay, and postoperative complication. No statistically significant differences in walking status and HHS were observed between the groups. No significant difference in cumulative survival was observed between the two groups (P=0.836), with a 1-year survival rate of 80% (95% confidence interval [CI], 71.8 to 87.5) in the IT group and 82% (95% CI, 73.1 to 89.4) in the FN group.
CONCLUSION
HA for unstable IT fractures in elderly patients showed clinical results and 1-year survival comparable to HA as the treatment of choice for displaced FN fractures in the same aging group.
LEVEL OF EVIDENCE
Level III, case-control study.
背景
虽然半髋关节置换术（HA）被认为是老年患者移位型股骨颈（FN）骨折的首选治疗方法，但HA也已部分作为不稳定型转子间（IT）骨折的替代治疗选择。然而，与老年患者移位型FN骨折的HA相比，关于不稳定型IT骨折HA的风险和可用性的数据较少。因此，我们进行了这项病例对照研究，以确定老年患者不稳定型IT骨折的HA是否能提供与移位型FN骨折的HA相当的临床结果和生存率。
假设
老年患者不稳定型IT骨折的HA能提供与同一年龄组移位型FN骨折的HA相当的临床结果和1年生存率。
材料与方法
我们确定了80例75岁及以上接受非骨水泥双极HA治疗不稳定型IT骨折（AO/OTA 31-A2.2/3和A3.3型）的患者。将他们的临床结果和1年生存率与80例接受相同手术治疗的移位型FN骨折（Garden 3型和4型）匹配对照组进行比较。研究两组患者的围手术期结果、术后并发症和1年生存率。术后6个月通过行走状态和Harris髋关节评分（HHS）评估功能结果。
结果
IT组的手术时间明显长于FN组（97.3分钟[50至255] vs. 79.3分钟[40至175]，P = 0.016）。然而，两组在围手术期结果方面没有显著差异，如总失血量、输血、术中骨折、住院时间和术后并发症。两组在行走状态和HHS方面未观察到统计学上的显著差异。两组之间的累积生存率没有显著差异（P = 0.836），IT组的1年生存率为80%（95%置信区间[CI]，71.8至87.5），FN组为82%（95%CI，73.1至89.4）。
结论
老年患者不稳定型IT骨折的HA显示出与同一年龄组移位型FN骨折的首选治疗方法HA相当的临床结果和1年生存率。
证据水平
III级，病例对照研究。
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