Ramoutar D N, Kodumuri P, Rodrigues J N, Olewicz S, Moran C G, Ollivere B J, Forward D P
ST8 Trauma and Orthopaedics, Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham, UK.
Eur J Orthop Surg Traumatol. 2017 Feb;27(2):267-272. doi: 10.1007/s00590-016-1887-3. Epub 2016 Dec 7.
Proximal femoral fractures in adults under 50 years are not as common as in the elderly, but may have just as significant an impact. There is little in the literature describing the functional outcomes of fixation in this age group. Our aim was to assess the clinical and functional outcomes of operative management of extracapsular proximal femoral fractures (AO 31-A) in the young adult (<50 years). Consecutive skeletally mature patients <50 years undergoing operative fixation of these fractures were obtained from a prospective database over a 12-year period. Complications and mortality data were obtained from this database and case note review. Outcome scores were obtained via postal questionnaires. Eighty-eight patients were included in the study of which 74 (84%) had fixation with the dynamic hip screw. The mean age was 39 years (range 17-50) with a male preponderance (73.8%). Mean hospital stay was 14 days (range 2-94). Seventeen (19.3%) patients had died at a mean of 40 months from their operation date. The 1-year mortality was 4.5%. There were five complications (5.7%). SF-36 and EuroQol 5D scores showed that 5-10% had severe problems with a 20% decrease in quality of life compared to population norms. The biggest differences were in the physical function modalities. One-third had fair to poor hip function as assessed by the Oxford Hip Score. Though these injuries are relatively rare in this age group, they do have significant mortality and functional impairment reflecting a higher energy of injury rather than the frailty seen in the elderly.
50岁以下成年人的股骨近端骨折不像老年人那样常见，但可能产生同样重大的影响。文献中几乎没有描述该年龄组内固定的功能结局。我们的目的是评估年轻成年人（<50岁）股骨近端囊外骨折（AO 31-A）手术治疗的临床和功能结局。在12年期间，从一个前瞻性数据库中选取了年龄<50岁、骨骼发育成熟且接受这些骨折手术固定的连续患者。并发症和死亡率数据来自该数据库及病例记录回顾。通过邮寄问卷获得结局评分。88例患者纳入研究，其中74例（84%）采用动力髋螺钉固定。平均年龄为39岁（范围17 - 50岁），男性占多数（73.8%）。平均住院时间为14天（范围2 - 94天）。17例（19.3%）患者在术后平均40个月时死亡。1年死亡率为4.5%。有5例并发症（5.7%）。SF-36和欧洲五维健康量表评分显示，与人群标准相比，5 - 10%的患者存在严重问题，生活质量下降20%。最大差异体现在身体功能方面。根据牛津髋关节评分，三分之一患者的髋关节功能为尚可至较差。尽管这些损伤在该年龄组相对少见，但确实有显著的死亡率和功能损害，这反映出损伤能量较高，而非老年人中常见的身体虚弱。
