对于大多数接受内固定治疗的20至69岁股骨颈骨折患者，功能结局良好，但健康相关生活质量未恢复：一项对182例患者的前瞻性2年随访研究。
Good functional outcome but not regained health related quality of life in the majority of 20-69 years old patients with femoral neck fracture treated with internal fixation: A prospective 2-year follow-up study of 182 patients.
作者信息
Campenfeldt Pierre, Hedström Margareta, Ekström Wilhelmina, Al-Ani Amer N
机构信息
Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm Sweden; Norrtälje Hospital, TioHundra AB. Box 905, 761 29 Norrtälje, Sweden.
Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm Sweden; Department of Orthopaedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
出版信息
Injury. 2017 Dec;48(12):2744-2753. doi: 10.1016/j.injury.2017.10.028. Epub 2017 Oct 18.
BACKGROUND AND PURPOSE
Prospective studies on patient related outcome in patients <70years with a femoral neck fracture (FNF) are few. We aimed to investigate functional outcome and health-related quality of life (HRQoL) in 20-69years old patients with a FNF treated with internal fixation.
PATIENTS AND METHODS
182 patients, 20-69years with a FNF treated with internal fixation were prospectively included in a multicenter study. Follow up included radiographic and clinical examination at 4, 12 and 24 months. Collected data were hip function using Harris Hip Score (HHS), HRQoL (EQ-5D and SF-36), fracture healing and re-operations.
RESULTS
At 24 months, HHS was good or excellent in 73% of the patients with a displaced fracture and 85% of the patients with a non-displaced fracture (p=0.15). Of the patients with displaced fracture (n=120), 23% had a non-union (NU) and 15% had an avascular necrosis (AVN) with a 28% re-operation rate. None of the patients with non-displaced fracture (n=50) had an NU, 12% had a radiographic AVN and 8% needed a re-operation. The mean EQ-5D in patients with displaced fracture decreased from 0.81 to 0.59 at 4 months, 0.63 at 12 months and 0.65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 0.88, 0.69, 0.75 and 0.74 respectively (p<0.001). The mean SF-total score in patients with displaced fracture decreased from 76 to 55 at 4 months, 63 at 12 months and 65 at 24 months (p<0.001). The corresponding values for patients with non-displaced fracture were 80, 67, 74 and 76 respectively (p<0.001).
INTERPRETATION
Two thirds of the patients with displaced femoral neck fracture healed after one operation and three quarters reported good or excellent functional outcome at 24 months. However, they did not regain their pre-fracture level of HRQoL.
背景与目的
关于70岁以下股骨颈骨折（FNF）患者与患者相关结局的前瞻性研究较少。我们旨在调查20至69岁接受内固定治疗的FNF患者的功能结局和健康相关生活质量（HRQoL）。
患者与方法
182例20至69岁接受内固定治疗的FNF患者前瞻性纳入一项多中心研究。随访包括在4、12和24个月时的影像学和临床检查。收集的数据包括使用Harris髋关节评分（HHS）评估的髋关节功能、HRQoL（EQ-5D和SF-36）、骨折愈合情况及再次手术情况。
结果
在24个月时，移位骨折患者中73%的Harris髋关节评分为良好或优秀，非移位骨折患者中这一比例为85%（p = 0.15）。在移位骨折患者（n = 120）中，23%发生骨不连（NU），15%发生股骨头缺血性坏死（AVN），再次手术率为28%。非移位骨折患者（n = 50）中无一例发生骨不连，12%有影像学股骨头缺血性坏死，8%需要再次手术。移位骨折患者的平均EQ-5D评分在4个月时从0.81降至0.59，12个月时为0.63，24个月时为0.65（p < 0.001）。非移位骨折患者的相应值分别为0.88、0.69、0.75和0.74（p < 0.001）。移位骨折患者的平均SF总分在4个月时从76降至55，12个月时为63，24个月时为65（p < 0.001）。非移位骨折患者的相应值分别为80、67、74和76（p < 0.001）。
解读
三分之二的移位股骨颈骨折患者一次手术后愈合，四分之三的患者在24个月时报告功能结局良好或优秀。然而，他们并未恢复到骨折前的HRQoL水平。
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