Wagner Boris C, Oliver William M, Bell Katrina R, Scott Chloe E H, Keating John F, White Timothy O, Clement Nick D, Duckworth Andrew D
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland.
J Bone Joint Surg Am. 2025 Apr 2;107(7):678-686. doi: 10.2106/JBJS.23.00582. Epub 2024 Dec 23.
There is a paucity of longer-term outcome data in younger adult patients who undergo fixation for an intracapsular hip fracture. The aims of this study were to evaluate the outcomes for young adult patients undergoing intracapsular hip fracture fixation and to assess factors associated with failure and patient-reported outcome measures (PROMs).
From 2008 to 2018, 112 consecutive patients ≤60 years of age (mean age, 48 years [range, 20 to 60 years]; 54% male) were retrospectively identified as having undergone fixation of an intracapsular hip fracture. Displaced fractures (n = 81) were more common than nondisplaced or minimally displaced fractures (n = 31). Failure was defined as loss of fixation, nonunion, or osteonecrosis. PROMs that were assessed included the Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D) index and Visual Analogue Scale (EQ-VAS), and University of California Los Angeles (UCLA) Activity Scale.
Eighty-six patients (77%) had union without evidence of failure, and 26 patients (23%) had a failure, including loss of fixation (6 patients; 5.4%), nonunion (5 patients; 4.5%), and osteonecrosis (16 patients; 14.3%). Overall, 39 patients (35%) required secondary surgery, with hardware removal (21 patients; 18.8%) and total hip arthroplasty (21 patients; 18.8%) being the most frequent procedures. Long-term functional outcomes were obtained for 81 patients (72%) at a mean of 7 years (range, 2.8 to 12.8 years). The median OHS was 47 (interquartile range [IQR], 40-48), the median FJS was 75 (IQR, 49-85), the median EQ-5D index was 1.00 (IQR, 0.77-1.00), and the median EQ-VAS was 90 (IQR, 70-95). The mean UCLA score fell from 6.8 preinjury to 6.0 postinjury (p < 0.001). Compared with the patients who had primary union, those who had a complication had significantly lower median OHS scores (44.5 versus 47, p = 0.008), EQ-5D index scores (0.825 versus 1.00, p = 0.001), EQ-VAS scores (70 versus 90, p = 0.01), and UCLA scores (4.5 versus 6.5, p = 0.001).
One in 4 young adult patients undergoing intracapsular hip fracture fixation had a failure. Failure was associated with inferior long-term function and health-related quality of life.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
对于接受接受囊囊内髋关节骨折进行固定治疗的年轻成年患者，长期预后数据较少。本研究的目的是评估接受囊内髋关节骨折固定治疗的年轻成年患者的预后，并评估与治疗失败及患者报告的预后指标（PROMs）相关的因素。
回顾性纳入2008年至2018年期间连续112例年龄≤60岁（平均年龄48岁[范围20至60岁]；54%为男性）接受囊内髋关节骨折固定治疗的患者。移位骨折（n = 81）比无移位或轻度移位骨折（n = 31）更常见。治疗失败定义为内固定失败、骨不连或骨坏死。评估的PROMs包括牛津髋关节评分（OHS）、遗忘关节评分（FJS）、欧洲五维健康量表（EQ - 5D）指数和视觉模拟量表（EQ - VAS）以及加利福尼亚大学洛杉矶分校（UCLA）活动量表。
86例患者（77%）骨折愈合且无失败迹象，26例患者（23%）出现治疗失败，包括内固定失败（6例；5.4%）、骨不连（5例；4.5%）和骨坏死（16例；14.3%）。总体而言，39例患者（35%）需要二次手术，其中取出内固定物（21例；18.8%）和全髋关节置换术（21例；18.8%）是最常见的手术。81例患者（72%）在平均7年（范围2.8至12.8年）时获得了长期功能预后。OHS中位数为47（四分位数间距[IQR]，40 - 48），FJS中位数为75（IQR，49 - 85），EQ - 5D指数中位数为1.00（IQR，0.77 - 1.00），EQ - VAS中位数为90（IQR，70 - 95）。UCLA评分均值从伤前的6.8降至伤后的6.0（p < 0.001）。与一期愈合的患者相比，出现并发症的患者OHS中位数得分显著更低（44.5对VS 47，p = 0.008）、EQ - 5D指数得分更低（0.825对VS 1.00，p = 0.001）、EQ - VAS得分更低（70对VS 90，p = 0.01）以及UCLA得分更低（4.5对VS 6.5，p = 0.001）。
接受囊内髋关节骨折固定治疗的年轻成年患者中，四分之一会出现治疗失败。治疗失败与较差的长期功能和健康相关生活质量相关。
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
