Ahmad Tashfeen, Muhammad Zehra Abdul, Habib Ahmed
Departments of Surgery and Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
Department of Surgery, Aga Khan University, Pakistan.
Ann Med Surg (Lond). 2019 Jul 11;45:54-58. doi: 10.1016/j.amsu.2019.07.015. eCollection 2019 Sep.
The elderly population is prone to hip fractures, and treating such patients to achieve good outcomes can be challenging. Collection of outcomes data can support clinicians to modify their treatment protocols and improve outcomes over time. The aim of this study is to compare different surgical procedures in patients with neck of femur and intertrochanteric fractures in terms of clinical, functional and radiological outcomes using injury-specific outcome scores.
The study data was derived from the existing single-center, prospective orthopaedic trauma registry initiated from July 2015. Functional, clinical and radiological outcomes were assessed using Modified Harris Hip Score and The Radiographic Union Score for Hip. Mean radiological outcome scores was compared by Mann-Whitney U test and deaths by Chi-square and Odds ratio.
Of the total 138 patients, 53 (38%) were neck of femur and 85 (62%) Intertrochanteric fractures with fall as leading cause of injury. At 12 months follow-up, modified Harris Hip Score showed 67% excellent-good results in both dynamic hip screw (N = 6) and total hip replacement (N = 3) followed by 50% in intramedullary nail (N = 2). Hemiarthroplasty has fair-poor outcomes with significantly higher deaths as compared to other procedure groups ( = 0.016). Radiological outcomes showed non-significant trend towards better outcomes in dynamic hip screw as compared to intramedullary nail ( = 0.08).
Our 12 months follow-up data suggest that dynamic hip screw and total hip replacement have better clinical, functional outcomes followed by intramedullary nail. Hemiarthroplasty has fair-poor clinical and functional outcomes with significantly higher deaths as compared to other procedure groups.
老年人群容易发生髋部骨折，治疗此类患者以取得良好疗效具有挑战性。收集疗效数据可支持临床医生修改治疗方案，并随着时间推移改善疗效。本研究的目的是使用特定损伤的疗效评分，比较股骨颈骨折和转子间骨折患者不同手术方法的临床、功能和放射学疗效。
研究数据来自于2015年7月启动的现有单中心前瞻性骨科创伤登记系统。使用改良Harris髋关节评分和髋关节放射学愈合评分评估功能、临床和放射学疗效。采用Mann-Whitney U检验比较平均放射学疗效评分，采用卡方检验和比值比比较死亡率。
在总共138例患者中，53例（38%）为股骨颈骨折，85例（62%）为转子间骨折，跌倒为主要损伤原因。在12个月随访时，改良Harris髋关节评分显示，动力髋螺钉（N = 6）和全髋关节置换（N = 3）的优良率均为67%，其次是髓内钉（N = 2）的优良率为50%。半髋关节置换术的疗效一般至较差，与其他手术组相比死亡率显著更高（P = 0.016）。放射学疗效显示，与髓内钉相比，动力髋螺钉有更好疗效的趋势但无统计学意义（P = 0.08）。
我们12个月的随访数据表明，动力髋螺钉和全髋关节置换术的临床和功能疗效较好，其次是髓内钉。半髋关节置换术的临床和功能疗效一般至较差，与其他手术组相比死亡率显著更高。
