Fagotti Lorenzo, de Menezes Ruth Losada, Ribeiro Darlan Martins, de Santana Maykon Lacerda, Maranho Daniel Augusto, Funghetto Silvana Schwerz
Post-Graduation Program of Sciences and Health Technology (Programa de Pós-Graduação em Ciências e Tecnologias em Saúde), Faculdade de Ceilândia, Universidade de Brasília (UnB), Brasília, DF, Brazil.
Instituto Vero Passo Saúde Integrada e Análise do Movimento, Brasília, DF, Brazil.
Medicine (Baltimore). 2025 Apr 18;104(16):e41792. doi: 10.1097/MD.0000000000041792.
This study aimed to investigate potential differences in spatiotemporal gait parameters and clinical outcomes between older adults undergoing intramedullary nailing (IN) and those undergoing total hip arthroplasty (THA) for unilateral hip fractures. A secondary objective was to identify predictors of postoperative falls in older adults following surgical treatment for hip fractures. We conducted a prospective study involving 42 community-dwelling older adults, assessed 6 months post-surgery. Of these participants, 21 (14 females, 7 males; mean age 76.0 ± 8.6 years) underwent IN, while the remaining 21 (10 females, 11 males; mean age 75.3 ± 7.7 years) received THA. Primary outcomes included gait speed and step width for both treatment groups, while secondary outcomes included the incidence of postoperative falls and additional clinical and spatiotemporal gait parameters. The mean gait speed was 73.5 ± 26.8 cm/s for the IN group and 79.7 ± 27.5 cm/s for the THA group (P = .46). Step width was significantly lower in the IN group (15.7 ± 2.7 cm) compared to the THA group (17.9 ± 3.3 cm; P < .05, effect size = 0.7). Postoperative falls were reported by 13 patients (31%) overall, with no significant differences between the 2 treatment groups. Multivariate logistic regression analysis identified an increased step width (≥18 cm, OR = 5.24; 95% CI: 0.98-27.97; χ² = 1.66, P = .05) as a potential independent risk factor for postoperative falls, while a higher modified Harris Hip score (≥80 points) was an independent protective factor (OR = 0.18; 95% CI: 0.03-0.97; χ² = -1.69; P = .04). The area under the curve was 0.889 (95% CI: 0.809-0.989; P < .001). The optimal cutoff point for the highest sensitivity (100%) and specificity (65.5%) was 0.217. Model accuracy for predicting postoperative falls was 76.2%. In conclusion, both IN and THA resulted in favorable clinical outcomes and comparable gait speeds following hip fracture surgery in older adults, though step width was greater in the THA group. Despite the high overall incidence of postoperative falls, no significant differences in fall occurrence were observed between the 2 treatment groups.
本研究旨在调查接受髓内钉固定术（IN）和全髋关节置换术（THA）治疗单侧髋部骨折的老年人在时空步态参数和临床结果方面的潜在差异。次要目标是确定髋部骨折手术治疗后老年人术后跌倒的预测因素。我们进行了一项前瞻性研究，纳入了42名社区居住的老年人，在术后6个月进行评估。在这些参与者中，21名（14名女性，7名男性；平均年龄76.0±8.6岁）接受了IN，其余21名（10名女性，11名男性；平均年龄75.3±7.7岁）接受了THA。主要结局包括两个治疗组的步态速度和步幅，次要结局包括术后跌倒的发生率以及其他临床和时空步态参数。IN组的平均步态速度为73.5±26.8cm/s，THA组为79.7±27.5cm/s（P = 0.46）。IN组的步幅（15.7±2.7cm）明显低于THA组（17.9±3.3cm；P < 0.05，效应大小 = 0.7）。总体上有13名患者（31%）报告了术后跌倒，两个治疗组之间无显著差异。多因素逻辑回归分析确定步幅增加（≥18cm，OR = 5.24；95%CI：0.98 - 27.97；χ² = 1.66，P = 0.05）是术后跌倒的潜在独立危险因素，而改良Harris髋关节评分较高（≥80分）是独立保护因素（OR = 0.18；95%CI：0.03 - 0.97；χ² = -1.69；P = 0.04）。曲线下面积为0.889（95%CI：0.809 - 0.989；P < 0.001）。最高灵敏度（100%）和特异性（65.5%）的最佳截断点为0.217。预测术后跌倒的模型准确率为76.2%。总之，IN和THA在老年髋部骨折手术后均产生了良好的临床结果且步态速度相当，尽管THA组的步幅更大。尽管术后跌倒的总体发生率较高，但两个治疗组之间在跌倒发生率上未观察到显著差异。
