'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Critical Care Department, Internal Clinical Research Area, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
J Arthroplasty. 2024 Jan;39(1):111-117. doi: 10.1016/j.arth.2023.06.035. Epub 2023 Jun 26.
We aimed to report implant survival in Garden type I and II femoral neck fractures treated with cannulated screws in elderly patients.
We retrospectively studied 232 consecutive unilateral Garden I and II patients (232 fractures) treated with cannulated screws. Mean age was 81 years (range, 65 to 100), and a body mass index of 25 (range, 15.8 to 38.3). No between-group differences were found in demographic variables and/or baseline measurements (P > .05). Mean follow-up was 36 months (range, 1 to 171). Two observers measured baseline radiographic variables with good-to-excellent interobserver reliability. The posterior tilt angle, measured on a cross-table lateral x-ray, was used to classify the cohort into <20° (n = 183) and ≥20° (n = 49). The cumulative incidence with competing risk analysis was used to predict association between posterior tilt and subsequent conversion to arthroplasty. Patient survival was calculated with the Kaplan-Meier estimate.
Implant survival was 86.3% (95% confidence interval (CI) 80 to 90) at 12 months and 77.3% (95% CI 64 to 86) at 70 months. The 12-month cumulative incidence failure was 12.6% (95% CI 8 to 17). After controlling for confounders, posterior tilt ≥20° had higher risk of subsequent arthroplasty when compared to posterior tilt <20° (38.8 [95% CI 25 to 52] versus 5% [95% CI 2.8 to 9], subhazard ratio 8.3, 95% CI 3.8 to 18), without any other radiologic or demographic factor being associated with failure. Patient survival was 88.2% (95% CI 83 to 91.7) at 12 months, 79.5% (95% CI 73 to 84) at 24 months, and 57% (95% CI 48 to 65) at 70 months.
Cannulated screws were a reliable treatment for Garden I and II fractures, except when there was posterior tilt ≥20°, where arthroplasty should be considered.
我们旨在报告Garden Ⅰ型和Ⅱ型股骨颈骨折患者使用空心螺钉治疗后的植入物存活率。
我们回顾性研究了 232 例单侧 Garden Ⅰ型和Ⅱ型（232 例骨折）患者，使用空心螺钉治疗。平均年龄为 81 岁（范围为 65 至 100 岁），体重指数为 25（范围为 15.8 至 38.3）。在人口统计学变量和/或基线测量方面，两组之间无差异（P＞.05）。平均随访时间为 36 个月（范围为 1 至 171 个月）。两名观察者使用良好至优秀的观察者间可靠性测量基线影像学变量。在骨盆侧位 X 线片上测量后倾角度，将队列分为＜20°（n=183）和≥20°（n=49）。使用竞争风险分析预测后倾与随后转换为关节置换术之间的相关性。使用 Kaplan-Meier 估计计算患者生存率。
术后 12 个月和 70 个月时，植入物存活率分别为 86.3%（95%可信区间为 80%至 90%）和 77.3%（95%可信区间为 64%至 86%）。术后 12 个月时的累积失效率为 12.6%（95%可信区间为 8%至 17%）。在控制混杂因素后，与后倾＜20°相比，后倾≥20°有更高的后续关节置换风险（38.8%[95%可信区间 25%至 52%]与 5%[95%可信区间 2.8%至 9%]，亚风险比为 8.3，95%可信区间为 3.8 至 18），没有其他影像学或人口统计学因素与失败相关。术后 12 个月、24 个月和 70 个月时，患者生存率分别为 88.2%（95%可信区间为 83%至 91.7%）、79.5%（95%可信区间为 73%至 84%）和 57%（95%可信区间为 48%至 65%）。
空心螺钉是 Garden Ⅰ型和Ⅱ型骨折的可靠治疗方法，除非存在后倾≥20°，否则应考虑关节置换术。
