University of Utah, Department of Orthopaedics, 590 Wakara Way, 84108, Salt Lake City, Utah, United States; Munich University Hospital LMU, Department of General, Trauma and Reconstructive Surgery, Marchioninistraße 15, 81337, Munich, Germany.
Munich University Hospital LMU, Department of General, Trauma and Reconstructive Surgery, Marchioninistraße 15, 81337, Munich, Germany.
Injury. 2019 Jul;50(7):1324-1328. doi: 10.1016/j.injury.2019.05.008. Epub 2019 May 17.
Early mobilization following hip fracture surgery is of superior importance especially in elderly hip fracture patients. Reduced mobilization can result in complications and increased mortality. In this study a gait analysis was performed using force-measuring insoles. We hypothesized, that patients with femoral neck fractures treated with hip replacement surgery load the affected limb more compared to patients with pertrochanteric fractures treated with fracture fixation. All patients (> 65 years) treated for a femoral neck fracture with hip replacement or a pertrochanteric fracture, respectively using fracture fixation with intramedullary nailing, were consecutively included in this study. For gait analysis, specific insole forcesensors (Loadsol®) were inserted into the footwear. Five days after surgery gait analysis was performed with a defined walking distance and all patients were instructed to transpose full weight. 20 patients following hip replacement surgery and 27 patients following intramedullary nailing were included. The hip replacement group loaded the affected limb with an average of 74.01% (SD 13.6) of bodyweight, while the fracture fixation group loaded a significantly reduced average of 62.70% (SD 8.3; p = 0.002). The results of the present study indicate that patients suffering from pertrochanteric fractures following fracture fixation are struggling to fully load the affected leg compared to patients suffering from femoral neck fractures treated with hip replacement surgery. The focus of further studies should concentrate on alternative analgesia and verify the cause of the observed difference in order to facilitate early full weight bearing especially in hip fracture patients following fracture fixation. The results indicate that in elderly patients, the fracture pattern and thus the surgical approach lead to a different weight bearing pattern. The primary therapeutic goal for elderly patients must be early mobilization at full weight bearing.
髋部骨折手术后的早期活动尤其重要，尤其是对于老年髋部骨折患者。减少活动可能会导致并发症和死亡率增加。在这项研究中，我们使用测力鞋垫进行了步态分析。我们假设，接受髋关节置换术治疗股骨颈骨折的患者与接受骨折内固定治疗股骨转子间骨折的患者相比，更多地负重受累肢体。所有 (> 65 岁) 接受髋关节置换术治疗股骨颈骨折或接受髓内钉内固定治疗股骨转子间骨折的患者均连续纳入本研究。进行步态分析时，将特定的鞋垫力传感器 (Loadsol®) 插入鞋中。术后 5 天，患者在规定的步行距离内进行步态分析，并指导所有患者完全负重。共纳入 20 例髋关节置换术后和 27 例髓内钉内固定术后患者。髋关节置换组平均以体重的 74.01% (SD 13.6) 负重受累肢体，而骨折固定组的平均负重明显减少，为 62.70% (SD 8.3; p = 0.002)。本研究结果表明，与接受髋关节置换术治疗股骨颈骨折的患者相比，接受骨折内固定治疗股骨转子间骨折的患者在完全负重受累肢体方面存在困难。进一步研究的重点应集中在替代镇痛方法上，并验证观察到的差异的原因，以便特别是在接受骨折内固定治疗的髋部骨折患者中促进早期完全负重。结果表明，在老年患者中，骨折类型和手术入路导致不同的负重模式。老年患者的主要治疗目标必须是早期完全负重活动。
