Division of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda MD, USA.
Department of Orthopaedics, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, 110 South Paca St., Baltimore, MD 21201, USA.
Injury. 2019 Dec;50(12):2158-2166. doi: 10.1016/j.injury.2019.09.039. Epub 2019 Oct 1.
Internal fixation remains the treatment of choice for non-displaced femoral neck fractures in elderly patients. Improved outcomes with arthroplasty following displaced femoral neck fractures may indicate that outcomes of non-displaced patterns should be reexamined. The aim of our study was to conduct a systematic review of the orthopaedic literature to determine the outcomes of internal fixation for the treatment of non-displaced and minimally displaced femoral neck fractures in elderly patients.
Relevant articles were identified using PubMed, Embase, and CENTRAL databases. Manuscripts were included if they contained (1) patients 60 years or older with (2) nondisplaced or minimally displaced (Garden I or II) femoral neck fractures (3) treated with internal fixation (4) separately reported outcomes in this patient population. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospitalization, infection, and transfusions. Fixed and random effects modeling was used to determine pooled estimates of the outcomes.
Twenty-seven studies were identified with a total of 21,155 patients, all of which were treated with internal fixation. The pooled risk of reoperation was 14.1% (95% CI: 10.6-18.2). The risk of one-year mortality was 14.6% (95% CI: 11.5-18.2) based on the reporting in 15 studies.
The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14%. This complication profile may be unacceptably high. Arthroplasty may offer improved short-term functional outcomes and a reduced risk of reoperation. However, there is currently little evidence to consider this treatment to be an alternative to internal fixation.
对于老年患者的非移位股骨颈骨折，内固定仍然是治疗的首选。移位股骨颈骨折后关节置换术的疗效改善可能表明，应重新检查非移位模式的疗效。我们的研究旨在对骨科文献进行系统评价，以确定内固定治疗老年患者非移位和轻度移位股骨颈骨折的疗效。
使用 PubMed、Embase 和 CENTRAL 数据库确定相关文章。如果包含以下内容的手稿可纳入：（1）60 岁或以上的患者；（2）非移位或轻度移位（Garden I 或 II）股骨颈骨折；（3）采用内固定治疗；（4）在该患者人群中单独报告结果。主要结局是再次手术。次要结局包括死亡率、患者报告的结果、住院时间、感染和输血。采用固定效应和随机效应模型来确定结局的汇总估计值。
共确定了 27 项研究，共有 21155 名患者，所有患者均采用内固定治疗。再次手术的总体风险为 14.1%（95%CI：10.6-18.2）。基于 15 项研究的报告，一年死亡率的风险为 14.6%（95%CI：11.5-18.2）。
老年非移位股骨颈骨折患者采用内固定治疗后再次手术和死亡率的风险超过 14%。这种并发症发生率可能高得无法接受。关节置换术可能提供更好的短期功能结果和降低再次手术的风险。然而，目前几乎没有证据表明这种治疗可以替代内固定。
