优化老年股骨颈骨折患者的手术策略：合并症的关键作用。
Optimizing Surgical Strategies for Elderly Patients With Femoral Neck Fracture: The Critical Role of Comorbidities.
作者信息
Peng Ye, Qi Xuezhu, Yu Mingzhi, Zhang Gongzi, Guo Moning, Zheng Jianpeng, Feng Lu, Wei Zaihua, Su Jianting, Yi Danhui, Liu Xinyu, Yao Yao, Zhang Lihai
机构信息
From the Department of Orthopaedics, Chinese PLA General Hospital, Beijing, People's Republic of China (Dr. Peng, Dr. Gongzi Zhang, Dr. Lihai Zhang); the Renmin University of China, Center for Applied Statistics and School of Statistics, Beijing, People's Republic of China (Qi, Yi); the Peking University, School of Public Health, Beijing, People's Republic of China (Yu, Dr. Yao); the Peking University, China Center for Health Development Studies, Beijing, People's Republic of China (Yu, Dr. Yao); the Beijing Municipal Health Commission, Information and Statistics Division (Beijing Municipal Health Commission Policy Research Center), Beijing, People's Republic of China (Guo, Zheng, Feng); the Beijing Center for Disease Prevention and Control, Beijing, People's Republic of China (Wei, Su); the Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China (Dr. Liu); and the Department of Emergency Medicine, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Medical, Qilu Hospital of Shandong University, Jinan, People's Republic of China (Dr. Lihai Zhang).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2025 Sep 9;9(9). doi: 10.5435/JAAOSGlobal-D-25-00062. eCollection 2025 Sep 1.
BACKGROUND
Femoral neck fractures (FNFs) pose a notable challenge in the elderly population, given the high associated mortality rates and costs. The choice between internal fixation (IF) and hip arthroplasty (HA) has long been debated, yet existing guidelines often overlooked the crucial influence of comorbidities. With the increasing number of hip fracture cases globally and the complexity of patient conditions, it is essential to identify the key factors that truly affect surgical outcomes.
METHODS
We conducted a large-scale retrospective study across 152 Beijing hospitals, including 25,764 patients aged 60+ years with FNF. After excluding those with severe preexisting conditions, we collected data on patient characteristics and used advanced statistical methods for analysis.
RESULTS
Among the patients, 4568 received IF and 21,196 received HA. IF decreased 1-year mortality in patients with fewer than four comorbidities, whereas HA was more beneficial for those with four or more comorbidities. Mortality predicted by comorbidities was notably lower than that by age and sex (2.379% versus 2.790%, P < 0.001), and age had no marked influence on outcomes.
CONCLUSION
In summary, for elderly patients with FNF, comorbidity profile, rather than age or sex, should be the key determinant in surgical choices to reduce all-cause mortality. These findings support the refinement of surgical guidelines and have implications for geriatric care. Future research should focus on enhancing comorbidity assessment in surgical planning.
背景
股骨颈骨折（FNFs）在老年人群中构成了显著挑战，因为其具有较高的相关死亡率和成本。长期以来，内固定（IF）和髋关节置换术（HA）之间的选择一直存在争议，但现有指南往往忽视了合并症的关键影响。随着全球髋部骨折病例数量的增加以及患者病情的复杂性，确定真正影响手术结果的关键因素至关重要。
方法
我们对北京152家医院进行了大规模回顾性研究，纳入了25764例60岁及以上的股骨颈骨折患者。在排除那些有严重基础疾病的患者后，我们收集了患者特征数据，并使用先进的统计方法进行分析。
结果
在这些患者中，4568例接受了内固定，21196例接受了髋关节置换术。内固定降低了合并症少于四种的患者的1年死亡率，而髋关节置换术对合并症四种或更多的患者更有益。合并症预测的死亡率明显低于年龄和性别预测的死亡率（2.379%对2.790%，P<0.001），且年龄对结果没有显著影响。
结论
总之，对于老年股骨颈骨折患者，手术选择的关键决定因素应是合并症情况，而非年龄或性别，以降低全因死亡率。这些发现支持完善手术指南，并对老年护理有启示意义。未来研究应聚焦于在手术规划中加强合并症评估。
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