Rezaie W, Wei W, Cleffken B I, van der Vlies C H, Cleffken B I, Roukema G R
Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
Open Orthop J. 2016 Dec 8;10:765-771. doi: 10.2174/1874325001610010765. eCollection 2016.
The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities.
We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay.
80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% 9.1% respectively, P=0.008). The 6-month mortality rates didn't differ between the IF and the HA groups (respectively 28.0% 34.5%, P=0.62).
The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.
对于移位的股骨颈囊内骨折的老年人，治疗的选择是假体置换。然而，这对于患有多种合并症的老年患者来说是一个重大的外科手术，可能会威胁血流动力学稳定性并导致死亡。在本研究中，我们比较了内固定（IF）和半髋关节置换术（HA）治疗患有严重合并症的老年人股骨颈囊内骨折的结果。
我们对2009年1月至2011年6月期间入住我们二级创伤中心且患有股骨颈骨折的所有患者进行了一项回顾性队列研究。纳入标准为：70岁及以上，美国麻醉医师协会（ASA）分级为3级或更高，移位的股骨颈骨折，以及采用内固定或骨水泥半髋关节置换术治疗。主要结局是6个月死亡率。次要结局是30天死亡率、术后并发症、再次手术率和住院时间。
80名患者符合我们的纳入标准。IF组的平均年龄为81.6岁，HA组为84.5岁（P = 0.07）。术后34 - 64个月检索病历。HA组发现2例因骨水泥植入综合征导致的术中死亡，IF组无术中死亡。HA组12例患者（21.8%）术后30天内死亡，IF组2例（8.0%）（P = 0.21）。HA组的平均手术时间为83分钟，IF组为51分钟（P = 0.000）。IF组与植入物相关的并发症比HA组更多（分别为36%和9.1%，P = 0.008）。IF组和HA组的6个月死亡率无差异（分别为28.0%和34.5%，P = 0.62）。
对于移位的股骨颈骨折且ASA分级为3至5级的老年患者，IF组和HA组的术后死亡率无差异。然而，在该组中，HA与植入物相关的并发症比IF少，因此是首选治疗方法。
