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外翻嵌插型股骨颈骨折原位固定与闭合复位后固定的比较:一项多中心研究

Comparison Between in Situ Fixation and Fixation After Closed Reduction in Valgus-Impacted Femoral Neck Fractures: A Multicenter Study.

作者信息

Jang Byung-Woong, Park Jung-Wee, Nho Jae-Hwi, Kim Jinjae, Kim Tae-Young, Lee Young-Kyun, Kim Jin-Woo

机构信息

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, South Korea.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.

出版信息

J Orthop Trauma. 2025 Mar 1;39(3):127-131. doi: 10.1097/BOT.0000000000002942.

Abstract

OBJECTIVES

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 years and older with valgus-impacted femoral neck fractures using data from multiple centers.

DESIGN

Retrospective multicenter cohort study.

SETTING

Five tertiary-care university hospitals.

PATIENT SELECTION CRITERIA

Patients aged 50 years and older, treated with operative fixation of valgus-impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019.

OUTCOME MEASURES AND COMPARISONS

Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score, and Koval grade were compared.

RESULTS

The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50-95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs. 26.7% of fixation after CR group, P = 0.002). Reoperation was required for 10.2% (7.5% of the in situ fixation group vs. 20% of the fixation after CR group, P = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after the CR group than in the in-situ fixation group (odds ratio = 4.757, P = 0.002 and odds ratio = 3.104, P = 0.023, respectively). At the 2-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs. 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the 2 groups ( P = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group ( P = 0.027, 0.044, respectively). Postoperative EQ-5D and Harris Hip Score scores showed no statistically significant differences between the 2 groups.

CONCLUSIONS

In patients aged 50 years or older with valgus-impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared with in-situ fixation. There was no significant difference in the incidence of ONFH in valgus-impacted femoral neck fractures regardless of whether reduction was performed.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

本研究的目的是利用多中心数据,比较50岁及以上外翻嵌插型股骨颈骨折患者原位固定与闭合复位(CR)后固定的临床结果。

设计

回顾性多中心队列研究。

地点

五家三级医疗大学医院。

患者选择标准

2003年至2019年期间,年龄在50岁及以上,采用多枚空心螺钉手术固定外翻嵌插型股骨颈骨折的患者。

结局指标及比较

比较两组(原位固定组和CR后固定组)的固定失败、股骨头坏死(ONFH)和再次手术等并发症。比较术后欧洲五维健康量表(EQ-5D)、Harris髋关节评分和Koval分级。

结果

符合纳入标准的206例患者(原位固定组161例,CR后固定组45例)的平均年龄为68.9±10.9岁(范围50-95岁)。男性39例,女性167例。固定失败发生率为11.2%(原位固定组为6.8%,CR后固定组为26.7%,P=0.002)。10.2%的患者需要再次手术(原位固定组为7.5%,CR后固定组为20%,P=0.023)。CR后固定组的固定失败率和再次手术率显著高于原位固定组(优势比分别为4.757,P=0.002和优势比为3.104,P=0.023)。在2年随访时,ONFH发生率为5.8%(原位固定组161例中有9例,CR后固定组45例中有3例)。两组间ONFH的发生率无显著差异(P=0.727)。原位固定组在6个月和12个月时的Koval分级结果更好(分别为P=0.027,0.044)。两组术后EQ-5D和Harris髋关节评分无统计学显著差异。

结论

在50岁及以上外翻嵌插型股骨颈骨折患者中,复位后固定时,与原位固定相比,因固定失败导致的再次手术率更高。无论是否进行复位,外翻嵌插型股骨颈骨折的ONFH发生率无显著差异。

证据水平

治疗性III级。有关证据水平的完整描述,请参阅作者指南。

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