Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
Aging Clin Exp Res. 2022 Nov;34(11):2825-2833. doi: 10.1007/s40520-021-01976-y. Epub 2021 Sep 10.
This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) in elderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.).
A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5 months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life.
Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2 year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2 years (OR 0.137; 95% CI 0.030-0.630; p = 0.011).
THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.
本研究旨在比较全髋关节置换术（THA）和人工股骨头置换术（HA）治疗伴有神经肌肉失衡（如中风、帕金森病等）的老年股骨颈骨折患者的临床疗效。
本研究回顾性分析了单中心 226 例伴有神经肌肉失衡的老年股骨颈骨折患者接受 THA 或 HA 治疗的临床资料。平均随访时间为 40.5 个月（范围 24-78 个月），主要终点为二次髋关节手术，次要终点包括功能、疼痛、健康相关生活质量、并发症和死亡。采用 Kaplan-Meier 生存曲线确定估计生存率，以再次手术为终点。采用 logistic 回归分析评估不同手术方式对死亡率的影响，采用线性回归分析评估功能、疼痛和生活质量。
THA 组以任何原因再次手术为终点的 Kaplan-Meier 生存率为 90.3%（95%CI 82.3-98.3），与 HA 组的 95.9%（95%CI 93.0-98.8）无显著差异（p=0.137）。两组中最常见的再次手术原因是脱位。两组术后并发症（包括脱位）无显著差异。与 HA 相比，THA 具有更好的功能结局、生活质量和较低的疼痛强度。值得注意的是，两组 2 年死亡率无差异，但 HA 组 2 年后死亡率更高（OR 0.137；95%CI 0.030-0.630；p=0.011）。
THA 是治疗伴有神经肌肉失衡的老年股骨颈骨折的有效方法。
