Department of Trauma, Hand and Reconstructive Surgery, Saarland Univesity, Kirrberger Strasse 1, D-66421, Homburg, Saarland, Germany.
Ethianum Clinic, Heidelberg, Germany.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3173-3181. doi: 10.1007/s00402-022-04602-2. Epub 2022 Sep 2.
Femoral neck fractures (FNF) are one of the most frequent fractures among elderly patients and commonly require surgical treatment. Bipolar hip hemiarthroplasty (BHHA) is mostly performed in these cases.
In the present retrospective study geriatric patients with FNF (n = 100) treated either by anterior minimal-invasive surgery (AMIS; n = 50) or lateral conventional surgery (LCS; n = 50) were characterized (age at the time of surgery, sex, health status/ASA score, walking distance and need for walking aids before the injury) and intraoperative parameters (duration of surgery, blood loss, complications), as well as postoperative functional performance early (duration of in-patient stay, radiological leg length discrepancy, ability to full weight-bearing, mobilization with walking aids) and 12 months (radiological signs of sintering, clinical parameters, complication rate) after surgery were analyzed.
Patients in the AMIS group demonstrated a reduced blood loss intraoperatively, while the duration of surgery and complication rates did not differ between the two groups. Further, more patients in the AMIS group achieved full weight-bearing of the injured leg and were able to walk with a rollator or less support during their in-patient stay. Of interest, patients in the AMIS group achieved this level of mobility earlier than those of the LCS group, although their walking distance before the acute injury was reduced. Moreover, patients of the AMIS group showed equal leg lengths postoperatively more often than patients of the LCS group. No significant differences in functional and surgery-related performance could be observed between AMIS and LCS group at 12 months postoperatively.
In conclusion, geriatric patients treated by AMIS experience less surgery-related strain and recover faster in the early postoperative phase compared to LCS after displaced FNF. Hence, AMIS should be recommended for BHHA in these vulnerable patients.
股骨颈骨折（FNF）是老年患者中最常见的骨折之一，通常需要手术治疗。在这些情况下，大多采用双极髋关节半髋关节置换术（BHHA）。
在本回顾性研究中，对接受前路微创（AMIS；n=50）或外侧常规手术（LCS；n=50）治疗的股骨颈骨折老年患者进行了特征描述（手术时的年龄、性别、健康状况/ASA 评分、受伤前的步行距离和是否需要助行器）以及术中参数（手术时间、失血量、并发症），以及术后早期（住院时间、影像学下肢长度差异、完全负重能力、助行器辅助下的活动能力）和 12 个月（烧结影像学迹象、临床参数、并发症发生率）的功能表现。
AMIS 组患者术中失血量减少，而两组手术时间和并发症发生率无差异。此外，AMIS 组更多的患者能够实现受伤下肢的完全负重，并且在住院期间能够使用助行器或更少的支撑行走。有趣的是，AMIS 组的患者比 LCS 组更早地达到了这种活动水平，尽管他们在急性损伤前的步行距离减少了。此外，AMIS 组患者术后下肢长度相等的情况比 LCS 组更常见。在术后 12 个月时，AMIS 和 LCS 组在功能和手术相关表现方面没有显著差异。
总之，与 LCS 相比，接受 AMIS 治疗的老年移位股骨颈骨折患者在手术后早期经历的手术相关应激较小，恢复较快。因此，对于这些脆弱的患者，应推荐 AMIS 用于 BHHA。
