Liu Yang, Zhang Chong-Wei, Zhao Xiao-Dan
Department of Orthopedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
Department of Laboratory Medicine, West China Hospital of Sichuan University, Wai Nan Guo Xue Lane No. 37, Wuhou District, Chengdu, Sichuan Province, P.R. China, 610041.
BMC Musculoskelet Disord. 2020 Apr 8;21(1):217. doi: 10.1186/s12891-020-03249-7.
The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period.
From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions.
Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P-P) = 53 (59) versus median (P-P) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group.
Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.
中国人口老龄化预计将导致九旬老人和百岁老人数量增加。九旬老人髋部骨折患者的死亡率与受伤后5年的普通人群死亡率相当。评估这个规模小但极具挑战性的患者亚组的5年死亡率对于优化患者管理至关重要。本项回顾性研究的主要目的是比较在16年期间因股骨颈骨折接受关节置换术或非手术治疗的90岁以上患者的5年生存率。
纳入1998年1月至2014年12月期间我院收治的所有连续的股骨颈骨折九旬老人和百岁老人患者进行评估。主要结局定义为受伤后30天、1年、3年和5年的死亡率。采用Kaplan-Meier法进行生存分析。使用对数秩检验进行分层分析，以比较受伤后总体累积死亡率和三个时间点（1年、3年和5年）的死亡率差异以及生存分布差异。
在16年的研究期间，关节置换术组和非手术治疗组分别包括33例和53例患者。关节置换术组的长期生存概率显著高于非手术治疗组（p = 0.002）。关节置换术组的生存时间显著高于非手术治疗组（中位数（P-P）= 53（59）对中位数（P-P）= 22（52），p = 0.001）。非手术组和关节置换术组在五个时间点（1、2、3、4和5年）的死亡率差异（除30天死亡率外）均具有显著性。受伤后三个时间点（1、3和5年）的总体累积死亡率和死亡率的分层分析表明，非手术治疗组的累积死亡率显著高于关节置换术组。
我们的研究表明，与非手术治疗相比，关节置换术更有可能提高90岁以上股骨颈骨折患者的长期生存率。可以预期，近一半的患者术后将存活超过5年。
