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55 岁至 70 岁患者移位股骨颈骨折内固定后失败率高,关节置换后疗效好。

High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years.

机构信息

a Department of Orthopaedic Surgery , Akershus University Hospital , Lørenskog , Norway.

b Norwegian Hip Fracture Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen.

出版信息

Acta Orthop. 2018 Feb;89(1):53-58. doi: 10.1080/17453674.2017.1376514. Epub 2017 Sep 15.

Abstract

Background and purpose - The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods - We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results - Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation - This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.

摘要

背景与目的-55 岁至 70 岁之间的移位型囊内股骨颈骨折患者的治疗仍存在争议。我们利用挪威髋关节骨折登记处的数据,比较了内固定(IF)、双极半髋关节置换术(HA)和全髋关节置换术(THA)在死亡率、再次手术和患者报告的结果方面的差异。

患者和方法-我们纳入了 2005 年至 2012 年间治疗的 2713 名患者。1111 名患者接受 IF 治疗,1030 名患者接受 HA 治疗,572 名患者接受 THA 治疗。主要再手术(定义为再内固定、二次关节置换、置换、假体部件的取出和 Girdlestone 手术)、患者报告的结果测量(满意度、疼痛和健康相关生活质量(EQ5D)在 4 个月和 12 个月后)、1 年死亡率和研究期间治疗方法的变化。

结果-IF 组的主要再手术率为 27%,HA 组为 3.8%,THA 组为 2.8%。549 名患者(总研究人群的 20%)回答了两份问卷。与 IF 相比,THA 治疗的患者在 4 个月和 12 个月时满意度更高,4 个月和 12 个月时疼痛减轻,4 个月和 12 个月时 EQ5D 指数评分更高,4 个月时 EQ-VAS 评分更高。与 IF 相比,HA 治疗的患者在 4 个月时满意度更高,疼痛减轻。EQ5D 指数和 EQ-VAS 相似。HA 治疗的患者 1 年死亡率较高,且合并症多于 THA 和 IF 组。所有这些差异均具有统计学意义和临床意义。

解释-这项研究表明 IF 后再手术率较高,THA 和 HA 后患者报告的结果较好,随访时间为中期。选择 HA 治疗的患者比 THA 或 IF 治疗的患者身体更虚弱。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9087/5810833/de26b4711a33/iort-89-53.F01.jpg

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