Department of Bone and Joint Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Department of Bone and Joint Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Injury. 2020 Apr;51(4):1021-1024. doi: 10.1016/j.injury.2020.02.098. Epub 2020 Feb 20.
Internal fixation (IF) with cannulated screws is the most widely accepted operation method for nondisplaced femoral neck fractures (FNFs) in elderly patients. However, there were higher rate of reoperation, severe complications and poorer functional outcomes reported in these patients treated with IF. The purpose of this research is to compare the prognosis, complications, reoperation and mortality of bipolar hemiarthroplasty (HA) with IF of cannulated screws in elderly patients.
All elderly patients (>75 years of age) with nondisplaced FNFs from January 2010 to December 2015 at our institution were included in this study. Patients treated with HA and IF with cannulated screws were compared. Outcome measures included the surgical complications, perioperative parameters, hip joint function, reoperation and mortality.
The blood loss of HA group (150.0 ± 55.1 mL) was statistically more than IF group (40.5 ± 15.7 mL, p = 0.001). However, the blood transfusion rate was similar between two groups (p = 0.102). At the last follow-up, there were total 14 (34.1%) severe surgical complications in the IF group, compared to 9 (10.1%) in the HA group (P = 0.001). No difference was detected between two groups with respect to the HHS and VAS at the last follow-up. Compared with the HA group, the IF group had much more reoperation in the follow up period (p = 0.001). There was no statistically differences of mortality rate between HA group (39.3%, 35/89) and IF group (34.1%, 14/41) (p=0.571).
As a treatment option for nondisplaced intracapsular FNFs in elderly patients, HA showed the merits of a less surgical complications and less reoperations, while IF demonstrated a shorter surgical time and less intraoperative blood loss. Meanwhile, there was no significant difference in the hip joint function and mortality rate in midterm follow-up. Further evaluation with a longer follow-up is recommended to strengthen these findings.
对于老年股骨颈骨折（FNF）非移位患者，空心螺钉内固定（IF）是最广泛接受的手术方法。然而，接受 IF 治疗的这些患者报告的再手术率、严重并发症和较差的功能结果更高。本研究旨在比较双极半髋关节置换术（HA）与空心螺钉 IF 治疗老年患者的预后、并发症、再手术和死亡率。
本研究纳入了 2010 年 1 月至 2015 年 12 月我院收治的所有非移位股骨颈骨折（FNF）老年患者（年龄>75 岁）。比较了接受 HA 和 IF 空心螺钉治疗的患者。观察指标包括手术并发症、围手术期参数、髋关节功能、再手术和死亡率。
HA 组（150.0 ± 55.1 mL）的失血量明显多于 IF 组（40.5 ± 15.7 mL，p = 0.001）。但两组输血率相似（p = 0.102）。末次随访时，IF 组有 14 例（34.1%）严重手术并发症，HA 组有 9 例（10.1%）（p = 0.001）。两组末次随访髋关节功能评分（HHS）和视觉模拟评分（VAS）无差异。与 HA 组相比，IF 组在随访期间有更多的再手术（p = 0.001）。HA 组（39.3%，35/89）和 IF 组（34.1%，14/41）死亡率无统计学差异（p=0.571）。
对于老年非移位囊内股骨颈骨折患者，HA 作为一种治疗选择具有手术并发症少、再手术少的优点，而 IF 则具有手术时间短、术中失血量少的优点。同时，在中期随访中，髋关节功能和死亡率无显著差异。建议进行更长时间的随访以加强这些发现。
