Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany.
Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1841-1850. doi: 10.1007/s00068-020-01559-y. Epub 2021 Jan 3.
Medial femoral neck fractures are typically managed with hemiarthroplasty (HA) or total hip arthroplasty (THA) in elderly patients. There is a debate as to which treatment predominates. The literatures have reported better outcomes for those patients with proximal femur fracture who were treated in an orthogeriatric centres compared to standard orthopaedic hospitals. Therefore, we have analysed the differences of outcome between HA and THA on patients, exclusively treated in orthogeriatric co-management and compared the results with the available literature.
We conducted a retrospective registry analysis of the Registry for Geriatric Trauma DGU. Between 2016 and 2018, data for 16,236 patients from 78 different hospitals were available: they were analysed univariably, and differences between HA and THA were examined using propensity score matching, according to the American Society of Anesthesiologists (ASA) grade, Identification-of-Seniors-At-Risk (ISAR) Score, anticoagulation level, sex, age, and walking ability prefracture.
There were 4,662 patients treated with HA and 892 with THA, meeting inclusion criteria. Patients in the HA group were older (84 years (IQR 80-89) vs. 79 years (IQR 75-83); p < 0.001), with more severe preexisting conditions, with an ASA grade ≥ 3 in 79% vs. 57% in the THA group (p < 0.001). After matching, the mortality rate, in-house revision rate, and quality of life (QoL) 7 days postoperatively were not significantly different by group. After 120 days, the HA group presented a lower rate of surgical complications (4% vs. 10%; p = 0.006), while the THA group had a higher rate of independent walking (18% vs. 28%; p = 0.001) and a higher QoL, measured by the EQ-5D-3L (0.81 (IQR 0.7-1.0) vs. 0.9 (IQR 0.72-1.0); p = 0.01).
Due to better walking ability and QoL, THA might be the better choice in healthier and more mobile patients, while HA would be better for multimorbid patients to avoid additional complication-associated treatments. Not the age of the patient but the preoperative condition might be important for the choice between THA and HA.
在老年患者中，股骨颈内侧骨折通常采用半髋关节置换术（HA）或全髋关节置换术（THA）治疗。哪种治疗方法更优仍存在争议。文献报道，与在标准骨科医院接受治疗的患者相比，在矫形老年病学中心接受治疗的股骨近端骨折患者的预后更好。因此，我们分析了专门在矫形老年病学共同管理下接受 HA 和 THA 治疗的患者之间的结果差异，并将结果与现有文献进行了比较。
我们对德国老年创伤登记处（Registry for Geriatric Trauma DGU）进行了回顾性登记分析。2016 年至 2018 年期间，来自 78 家不同医院的 16236 名患者的数据可用：我们进行了单变量分析，并根据美国麻醉医师协会（ASA）分级、老年人风险识别（ISAR）评分、抗凝水平、性别、年龄和骨折前行走能力，使用倾向评分匹配（propensity score matching）检查 HA 和 THA 之间的差异。
符合纳入标准的 HA 治疗患者有 4662 例，THA 治疗患者有 892 例。HA 组患者年龄更大（84 岁（IQR 80-89）vs. 79 岁（IQR 75-83）；p<0.001），合并症更严重，ASA 分级≥3 级的患者占 79%，而 THA 组为 57%（p<0.001）。匹配后，两组患者的死亡率、院内翻修率和术后 7 天的生活质量（QoL）无显著差异。120 天后，HA 组手术并发症发生率较低（4% vs. 10%；p=0.006），而 THA 组独立行走率较高（18% vs. 28%；p=0.001），且 EQ-5D-3L 评分较高（0.81（IQR 0.7-1.0）vs. 0.9（IQR 0.72-1.0）；p=0.01）。
由于 THA 具有更好的行走能力和 QoL，因此对于更健康、更活跃的患者而言，THA 可能是更好的选择，而 HA 则更适合合并多种疾病的患者，以避免因额外的并发症相关治疗而导致的风险。对于 HA 和 THA 的选择，重要的可能不是患者的年龄，而是术前的身体状况。
Zotero 插件