Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Arthroplasty. 2023 Aug;38(8):1522-1527. doi: 10.1016/j.arth.2023.01.057. Epub 2023 Feb 8.
Geriatric intertrochanteric fractures remain a major public health concern due to the considerable disability, morbidity, mortality, and health care costs associated with these injuries. The underlying poor bone quality and unstable nature of these fractures makes them difficult to treat. The main purpose of this study was to evaluate the outcome of hemiarthroplasty for unstable intertrochanteric hip fractures when compared to the traditional treatment options of open reduction internal fixation (ORIF).
A retrospective 1:1 matched cohort of 150 patients who had intertrochanteric fractures treated with either hemiarthroplasty or ORIF was developed using a local institutional database. Demographic, perioperative, and postoperative variables were collected with at least 1 year of patient follow-up. Statistical analyses were performed with use of Student's t-tests, chi-square tests, and analysis of variance.
Unstable intertrochanteric fractures treated with ORIF were associated with significantly more blood loss and an increased need for revision surgery. This effect was most pronounced in Arbeitsgemeinschaft für Osteosynthesefragen Orthopaedic Trauma Association classification type 31.A3 fractures, as patients treated with ORIF experienced significantly slower postoperative mobilization, increased blood loss, increased readmission, and revision surgery rates. Hemiarthroplasty was associated with an increased risk of greater trochanter escape, which did not appear to effect outcomes in this subset of patients.
Hemiarthroplasty may improve outcomes for patients with unstable intertrochanteric fractures. The benefit of this technique is likely maximized in Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association type 31.A3 fractures. It remains a good option in the hands of experienced surgeons.
老年人股骨转子间骨折仍然是一个主要的公共卫生问题，因为这些损伤与相当大的残疾、发病率、死亡率和医疗保健费用有关。这些骨折的潜在骨质量差和不稳定性质使得它们难以治疗。本研究的主要目的是评估半髋关节置换术治疗不稳定型股骨转子间骨折的效果，与传统的切开复位内固定（ORIF）治疗方法进行比较。
使用当地机构数据库开发了 150 例股骨转子间骨折患者的回顾性 1:1 匹配队列，这些患者分别接受半髋关节置换术或 ORIF 治疗。收集了至少 1 年患者随访的人口统计学、围手术期和术后变量。使用学生 t 检验、卡方检验和方差分析进行统计学分析。
接受 ORIF 治疗的不稳定型股骨转子间骨折与显著更多的失血和增加的翻修手术需求相关。这种影响在 Arbeitsgemeinschaft für Osteosynthesefragen Orthopaedic Trauma Association 分类类型 31.A3 骨折中最为明显，因为接受 ORIF 治疗的患者术后活动明显较慢，失血增加，再入院和翻修手术率增加。半髋关节置换术与大转子逃逸的风险增加相关，但在这组患者中似乎并未影响结果。
半髋关节置换术可能改善不稳定型股骨转子间骨折患者的预后。该技术的益处可能在 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 类型 31.A3 骨折中最大化。在经验丰富的外科医生手中，它仍然是一个不错的选择。
