Deng Yan, Zhou Xiang-Ping, Sun Bin, Li Guo-Hui, Tong Zuo-Ming
Department of Orthopedics, Loudi Central Hospital, No. 51 Chang qing Central Street, Lou Xing District, Loudi, Hunan, 417000, China.
Department of Radiology, Loudi Central Hospital, No. 51 Chang qing Central Street, Lou Xing District, Loudi, Hunan, 417000, China.
BMC Surg. 2025 Apr 3;25(1):130. doi: 10.1186/s12893-025-02866-0.
As the population continues to age, the occurrence of intertrochanteric femoral fractures (IFFs) has steadily increased. The main aims of this investigation were to evaluate and compare the clinical outcomes, ambulatory ability, overall survival, and all-cause mortality between two cephalic screws combined with compression proximal-femoral intramedullary nailing internal fixation (IF) and long-stemmed cemented bipolar hemiarthroplasty (LCHA) in patients aged 75 years and older. The secondary objective was to investigate the relative independent risk factors contributing to postoperative all-cause mortality.
A retrospective analysis was conducted on 251 elderly patients with IFF who underwent IF or LCHA between January 2018 and October 2022. We employed generalized estimation equations along with univariate and multivariate analyses to examine the impact of various surgical interventions and other pertinent factors on postoperative ambulatory ability and all-cause mortality outcomes. Associations between sex, age, number of comorbidities, aspartate aminotransferase (AST) levels, total blood transfusions, and mortality were analyzed via Cox proportional hazards models.
The analysis included a cohort of 120 patients from the IF group and 121 patients from the LCHA group. Statistically significant differences were not observed in the clinical outcomes, ambulatory ability, overall survival, or all-cause mortality after surgical treatment between the groups receiving IF and LCHA (p > 0.05). Nevertheless, among patients aged ≥ 85 years, the IF group demonstrated a lower rate of all-cause mortality than the LCHA group did (p < 0.05). As age increases and the number of preoperative comorbidities and the amount of perioperative transfusion increase, the preoperative AST level decreases, which is associated with a greater risk of postoperative death. (p < 0.05).
In elderly patients aged 75-84 years with intertrochanteric femur fractures, both internal fixation (IF) and long-stemmed cemented hemiarthroplasty (LCHA) are viable treatment options. However, for patients aged 85 years and older, IF is associated with a relatively lower postoperative all-cause mortality rate and should be prioritized as a treatment modality. Additionally, preoperative AST levels may serve as a valuable predictor of postoperative all-cause mortality in elderly patients undergoing surgery for intertrochanteric femur fractures.
随着人口持续老龄化，股骨转子间骨折（IFFs）的发生率稳步上升。本研究的主要目的是评估和比较75岁及以上患者接受双枚头钉联合股骨近端髓内钉加压内固定术（IF）和长柄骨水泥型双极半髋关节置换术（LCHA）后的临床疗效、步行能力、总生存率和全因死亡率。次要目的是研究导致术后全因死亡率的相对独立危险因素。
对2018年1月至2022年10月期间接受IF或LCHA治疗的251例老年IFF患者进行回顾性分析。我们采用广义估计方程以及单因素和多因素分析，以检验各种手术干预措施和其他相关因素对术后步行能力和全因死亡率结果的影响。通过Cox比例风险模型分析性别、年龄、合并症数量、天冬氨酸转氨酶（AST）水平、总输血量与死亡率之间的关联。
分析纳入了IF组的120例患者和LCHA组的121例患者。接受IF和LCHA治疗的两组患者术后临床疗效、步行能力、总生存率或全因死亡率未见统计学显著差异（p＞0.05）。然而，在年龄≥85岁的患者中，IF组的全因死亡率低于LCHA组（p＜0.05）。随着年龄增加、术前合并症数量和围手术期输血量增加，术前AST水平降低，这与术后死亡风险增加相关（p＜0.05）。
对于75 - 84岁的老年股骨转子间骨折患者，内固定术（IF）和长柄骨水泥型半髋关节置换术（LCHA）都是可行的治疗选择。然而，对于85岁及以上的患者，IF术后全因死亡率相对较低，应优先作为一种治疗方式。此外，术前AST水平可能是老年股骨转子间骨折手术患者术后全因死亡率的有价值预测指标。
