一项针对老年人无移位股骨颈骨折内固定与移位股骨颈骨折髋关节置换术的队列研究：一项临床试验的初步研究。
A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial.
作者信息
Mukka Sebastian, Sjöholm Pontus, Aziz Athir, Eisler Thomas, Kadum Bakir, Krupic Ferid, Morberg Per, Sayed-Noor Arkan
机构信息
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Department of clinical sciences at Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
出版信息
Pilot Feasibility Stud. 2020 Jul 11;6:98. doi: 10.1186/s40814-020-00642-w. eCollection 2020.
INTRODUCTION
The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations.
METHODS
A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups.
RESULTS
Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS.
CONCLUSIONS
In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.
TRIAL REGISTRATION
ClinicalTrial.org, NCT03392285. Retrospectively registered on 5 February 2018.
引言
关于无移位股骨颈骨折（FNF）的文献较少。这项前瞻性可行性研究的目的是比较采用内固定（IF）治疗的无移位FNF与采用髋关节置换术治疗的移位FNF的临床结果。我们假设髋关节置换术的再次手术发生率会更低。
方法
共纳入235例患者，中位年龄84岁（范围65 - 99岁）。连续65例无移位FNF患者接受IF治疗，170例移位FNF患者接受全髋关节置换术或半髋关节置换术。在1年时使用Harris髋关节评分（HHS）、WOMAC和疼痛数字评定量表（PNRS）进行随访访谈。最短随访时间为22个月。两组间基线数据无差异。
结果
19例（8%）髋关节至少需要再次手术一次，平均时间为6个月（范围0 - 35个月）。IF组的再次手术率高于髋关节置换术组（13.8%对5.9%，95%可信区间0.9 - 6.4）。总体1年和2年死亡率分别为28%和40%，两组间无差异。IF组再次手术最常见的原因是骨不连和缺血性坏死，6例患者接受了髋关节或切除关节成形术。在关节置换术组，最常见的指征是深部感染和脱位。我们在HHS、WOMAC和PNRS方面未发现两组间有任何差异。
结论
在这项可行性研究中，尽管IF组的再次手术率较高，但我们发现两组间患者报告的结果无差异。需要进一步的随机试验来确定老年人无移位FNF的最佳治疗方法。
试验注册
ClinicalTrial.org，NCT03392285。于2018年2月5日进行回顾性注册。
Zotero 插件