Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Sci Rep. 2021 Nov 2;11(1):21461. doi: 10.1038/s41598-021-01046-3.
Cementless bipolar hemiarthroplasty (BHA) recently gained popularity as a treatment for femur neck fracture (FNF), but there have been few studies comparing this with multiple screw fixation (MSF) in the elderly population. The purpose of this study is to compare (1) surgery-related parameters, (2) reoperation rate as a local complication, (3) in-hospital systemic complication rate, and (4) mortality rate at 1 year after MSF and cementless BHA in patients with FNF using nationwide data. Six-hundred sixty-six hips (aged ≥ 50 years) extracted from nationwide Hip Fracture Registry were included in this study (133 MSF and 533 cementless BHA). One hundred fifty-six hips were divided into nondisplaced FNF (Group A) and 510 into displaced FNF (Group B). We evaluated (1) surgery-related parameters (anesthesia type, time to surgery, operation time, estimated blood loss and volume of postoperative transfusion), (2) the rate of and reasons for reoperation, (3) the rate and type of in-hospital systemic complications and (4) one-year mortality rate after surgery. In Group A, MSF showed shorter operation time (p = 0.004) and lower incidence of in-hospital systemic complications (p = 0.003). In Group B, cementless BHA demonstrated lower reoperation rate than MSF (p < 0.001). In both Group A and B, cementless BHA was associated with higher estimated blood loss than MSF (p < 0.001). Based on findings in our study, MSF might be a more favorable option for nondisplaced FNF, whereas cementless BHA might be a better one for displaced FNF in patients older than fifty. Nevertheless, our nationwide study also showed that numbers of cementless BHAs were being performed for nondisplaced FNF even in teaching hospitals.
非骨水泥双极半髋关节置换术（BHA）最近作为股骨颈骨折（FNF）的治疗方法受到关注，但在老年人群中，将其与多枚螺钉固定（MSF）进行比较的研究较少。本研究旨在使用全国范围内的数据，比较（1）手术相关参数，（2）局部并发症再手术率，（3）住院期间全身并发症发生率，以及（4）MSF 和非骨水泥 BHA 治疗 FNF 患者 1 年后的死亡率。从全国髋关节骨折登记处提取了 666 髋（年龄≥50 岁），包括 133 例 MSF 和 533 例非骨水泥 BHA。156 髋分为无移位 FNF（A 组）和 510 髋为移位 FNF（B 组）。我们评估了（1）手术相关参数（麻醉类型、手术时间、手术时间、估计失血量和术后输血量），（2）再手术率和原因，（3）住院期间全身并发症的发生率和类型，以及（4）手术后 1 年的死亡率。在 A 组中，MSF 显示手术时间更短（p=0.004），且住院期间全身并发症发生率更低（p=0.003）。在 B 组中，非骨水泥 BHA 的再手术率低于 MSF（p<0.001）。在 A 组和 B 组中，非骨水泥 BHA 的估计失血量均高于 MSF（p<0.001）。根据本研究的结果，MSF 可能更适合无移位 FNF，而非骨水泥 BHA 可能更适合年龄大于 50 岁的移位 FNF。然而，我们的全国性研究还表明，即使在教学医院，也有越来越多的非骨水泥 BHA 用于治疗无移位 FNF。
