全髋关节置换术可降低股骨颈骨折后脱位的风险。

Total hip arthroplasty reduces the risk of dislocation after femoral neck fracture.

机构信息

Institute of Movement Science UMR 7287, Aix-Marseille université et CNRS, Marseille, France; Institute of Movement and Locomotion, Marseille, France.

Public Teaching Hospital of Paris, Ambroise-Paré Hospital, Paris, France.

出版信息

Orthop Traumatol Surg Res. 2023 Jun;109(4):103575. doi: 10.1016/j.otsr.2023.103575. Epub 2023 Feb 7.

DOI:10.1016/j.otsr.2023.103575

PMID:36754167

Abstract

INTRODUCTION

Femoral neck fracture in the elderly patient can either be managed using hemi-arthroplasty (HA) or total hip arthroplasty (THA). The aim of this study was to explore the rate of three selected complications in each procedure: is the dislocation rate higher with HA compared to THA? Is the blood transfusion rate higher with THA compared to HA? Do the patients who underwent THA require more ICU transfer than the patients who underwent HA? Is the ICU transfer correlated to the use of cement for stem fixation?

METHOD

Based on a national health-care database, a comparative and retrospective study was conducted. 96,184 patients were included after having a surgery for femoral neck fracture between 2014 and 2017. The mean follow up was 3.5 years (Min. 2 years-Max. 5 years). The population was divided into two groups: hemiarthroplasty (HA) and total hip arthroplasty (THA). The primary outcome was the dislocation rate and the secondary outcomes were the blood transfusion rate and the need for ICU after surgery.

RESULTS

At two years of follow up in the Hemiarthroplasty group, 3647 patients had a dislocation episode over 64,106 patients: 5.69%. In the Total Hip Arthroplasty group: 1904 patients had a dislocation episode over 32,078 patients: 5.94% (p=0.26711). The percentage of deceased patient without dislocation was 17.76% in the HA group and 11.56% in the THA group (p<0.001). The univariate hazard ratio for dislocation was higher in the THA group: HR 1.063 IC 95% (0.993-1.138) p=0.077. The multivariate analysis calculating competitive risk with death and dislocation found THA to be a protective factor of dislocation HR 0.926 IC 95% (0.866-0.991) p=0.0266. The rate of blood transfusion was 5.59% in the THA group and 7.03% in the HA group (p<0.001), The multivariate analysis found HR=1.062 IC 95% (0.99-1.139) p=0.0955. The need for ICU transfer after the surgery was 7.04% in the HA group and 8.08% in the THA group (p<0.001). The multivariate analysis found HR 0.995 IC 95% (0.921-1.076) p=0.9094. Finally, only cement was found as an independent risk factor of ICU transfer after surgery: HR 1.254 IC 95% (1.164-1.35) p<0.0001.

CONCLUSION

THA for femoral neck fracture allows to reduce the risk of dislocation compared to hemiarthroplasty. The multivariate analysis failed to prove the superiority of one procedure over the other regarding blood transfusion risk and the need for ICU transfer. The use of cemented stem appears to be a risk factor of ICU transfer after hip arthroplasty.

LEVEL OF EVIDENCE

III, Retrospective comparative study.

摘要

介绍

老年患者的股骨颈骨折可以通过半髋关节置换术（HA）或全髋关节置换术（THA）进行治疗。本研究旨在探讨每种手术的三种选定并发症的发生率：HA 与 THA 相比，脱位率是否更高？THA 与 HA 相比，输血率是否更高？与接受 HA 的患者相比，接受 THA 的患者需要更多的 ICU 转移吗？ICU 转移是否与用于固定股骨柄的水泥有关？

方法

基于国家医疗保健数据库，进行了一项比较性回顾性研究。纳入了 2014 年至 2017 年间接受股骨颈骨折手术的 96184 名患者。平均随访时间为 3.5 年（最短 2 年，最长 5 年）。人群分为两组：半髋关节置换术（HA）和全髋关节置换术（THA）。主要结局是脱位率，次要结局是手术后输血率和 ICU 转移率。

结果

在 HA 组的两年随访中，64106 名患者中有 3647 名患者发生脱位，发生率为 5.69%。在 THA 组中：32078 名患者中有 1904 名患者发生脱位，发生率为 5.94%（p=0.26711）。HA 组中无脱位死亡患者的百分比为 17.76%，THA 组中无脱位死亡患者的百分比为 11.56%（p<0.001）。THA 组脱位的单变量风险比更高：HR 1.063 IC 95%（0.993-1.138）p=0.077。计算与死亡和脱位竞争风险的多变量分析发现，THA 是脱位的保护因素，HR 0.926 IC 95%（0.866-0.991）p=0.0266。输血率在 THA 组为 5.59%，在 HA 组为 7.03%（p<0.001），多变量分析发现 HR=1.062 IC 95%（0.99-1.139）p=0.0955。HA 组术后 ICU 转移率为 7.04%，THA 组为 8.08%（p<0.001）。多变量分析发现 HR 0.995 IC 95%（0.921-1.076）p=0.9094。最后，只有水泥被发现是术后 ICU 转移的独立危险因素：HR 1.254 IC 95%（1.164-1.35）p<0.0001。