Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3469-3478. doi: 10.1007/s00402-024-05462-8. Epub 2024 Aug 28.
Hip fracture treatment should be as standardized and effective as possible, with emphasis on fast recovery and avoidance of complications, especially those leading to reoperations. There is accumulating evidence regarding the optimal treatment of hip fractures but reports of whether this has influenced treatment in the clinical setting are sparse. The objective of this study was to determine the trends of hip fracture incidence and treatment in Finland, with special regard to how we treat older patients compared to younger ones.
All operatively treated hip fractures in Finland between 1997 and 2018 were identified from a national administrative register. The incidence of these fractures and operations performed to treat them were calculated based on the adult population size.
Apart from a decline in the elderly age groups during the first half of the study period, the incidence of hip fractures remained relatively constant. However, the incidences of different operations changed significantly. In treatment of femoral neck fractures from 1997 to 2018, the incidence of cemented hemiarthroplasty (HA) increased from 41.1 to 59.9 per 100,000 person-years (10) and hybrid total hip arthroplasty (THA) from 0.56 to 5.93 per 10, while the incidence of internal fixation (IF) decreased, for instance screw fixation from 12.5 to 2.7 per 10. The incidence of cementless HA decreased from 13.3 to 1.2 per 10. These changes were much more pronounced in the elderly population and there was a statistically significant difference in the proportion of patients aged > 59 treated with cemented HA and IF in 1997 compared to 2018. For trochanteric and subtrochanteric fractures, treatment with intramedullary nails replaced extramedullary devices as the most common treatment method.
The changes in treatment methods in Finland correspond to the increasing knowledge available about the optimal treatment of hip fractures and global treatment trends.
髋部骨折的治疗应尽可能标准化和有效，重点是快速康复和避免并发症，特别是那些导致再次手术的并发症。关于髋部骨折的最佳治疗方法有越来越多的证据，但关于这是否影响了临床治疗的报告却很少。本研究的目的是确定芬兰髋部骨折的发病率和治疗趋势，特别关注我们如何治疗老年患者与年轻患者。
从国家行政登记处确定了 1997 年至 2018 年间在芬兰接受手术治疗的所有髋部骨折。根据成人人口规模计算这些骨折和治疗这些骨折的手术的发生率。
除了在研究前半段老年人群的发病率下降外，髋部骨折的发病率基本保持不变。然而，不同手术的发病率发生了显著变化。在 1997 年至 2018 年治疗股骨颈骨折方面，骨水泥半髋关节置换术（HA）的发病率从每 10 万人年 41.1 例增加到 59.9 例（10），杂交全髋关节置换术（THA）从 0.56 例增加到 5.93 例，而内固定（IF）的发病率则有所下降，例如螺钉固定从每 10 例 12.5 例下降到 2.7 例。骨水泥 HA 的发病率从每 10 例 13.3 例下降到 1.2 例。这些变化在老年人群中更为明显，在 1997 年与 2018 年之间，接受骨水泥 HA 和 IF 治疗的 > 59 岁患者的比例存在统计学差异。对于转子间和转子下骨折，髓内钉治疗取代了髓外器械，成为最常见的治疗方法。
芬兰治疗方法的变化与关于髋部骨折最佳治疗方法的日益增长的知识以及全球治疗趋势相吻合。
