Postoperative quality of life of internal fixation versus hemiarthroplasty for femoral neck fractures in the elderly

doi:10.3969/j.issn.2095-4344.2017.19.001

Abstract

Abstract:

BACKGROUND: The treatment strategy for femoral neck fractures has not been confirmed, and choosing internal fixation or arthroplasty remains controversial. After internal fixation, the occurrence of bone nonunion and osteonecrosis of femoral head makes its long-term treatment outcomes far from satisfactory. Can we improve the functional recovery through high-quality reduction, accurate fixation and active postoperative exercise? If so, it may be favorable for the elderly with femoral neck fractures, especially for those combined with other serious diseases.

OBJECTIVE: To compare the quality of life in the elderly with femoral neck fractures after internal fixation and hemiarthroplasty.

METHODS: 148 patients with femoral neck fractures aged more than 60 years old in the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2013 were analyzed retrospectively. The operation time, intraoperative blood loss, hospitalization time, mortality rate, reoperation rate and postoperative quality of life were compared between internal fixation and hemiarthroplasty in the patients with undisplaced femoral neck fractures (Garden type I or II) displaced femoral neck fractures (Garden type III or IV), respectively.

RESULTS AND CONCLUSION: (1) Among 148 patients, 137 cases completed follow-up, and the follow-up rate was 92.6%. (2) The operation time, intraoperative blood loss and hospitalization time in the internal fixation group were significantly superior to those in the hemiarthroplasty group in patients with displaced or undisplaced femoral neck fractures (P < 0.05). (3) There was no significant difference in the mortality rate between two groups, and the reoperation rate in the internal fixation groups was slightly higher than that in the hemiarthroplasty group. (4) The Harris and SF-36 scores in both groups were increased with time, and the difference between two groups was decreased with time, which became equal at 2.5 years postoperatively (P > 0.05). Besides, the time of the patients with undisplaced femoral neck fractures in the internal fixation group achieving the same quality of life with the hemiarthroplasty group was earlier than that of displaced ones. (5) These results suggest that internal fixation holds short operation time, simple operation skills and less trauma in the treatment of femoral neck fractures, and with the development of technology, it can achieve the early functional recovery. Thereafter, it is an effective method for senile femoral neck fractures.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Internal Fixators, Arthroplasty, Replacement, Hip, Quality of Life, Tissue Engineering

CLC Number:

R318

Hu Jun, Zhang De-qiang, Tang Xin. Postoperative quality of life of internal fixation versus hemiarthroplasty for femoral neck fractures in the elderly [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(19): 2953-2960.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入股骨颈骨折患者148例，按Garden分型分为无移位组和移位组，无移位组2例失访，移位组9例失访。 2.2 无移位型(GardenⅠ、GardenⅡ型)股骨颈骨折进行不同手术方式的组间比较内固定组的死亡率为21.4%，半髋置换组的死亡率为30.8%，2组间的死亡率差异无显著性意义；内固定中1例出现股骨头坏死而进行了半髋置换术，半髋置换组未出现翻修病例。 2.2.1 不同组间手术时间、术中出血量和住院时间的比较见图1及表2。 2.2.2 不同组间、不同时间的术后生活质量比较见图2，3及表3。内固定组的Harris评分由术后3个月的(62.1±5.0)分提高到术后 2.5 年的(87.3±3.4)分，差异有显著性意义(P < 0.05)；半髋置换组Harris评分由术后3个月的(71.3±4.3)分提高到术后2.5年的(85.9±3.0)分，差异有显著性意义(P < 0.05)。术后第3，6个月的Harris评分均为内固定组低于半髋置换组，差异有显著性意义(P < 0.05)；第12个月、2.5年Harris评分为2组间差异无显著性意义(P > 0.05)。可见虽然内固定组的Harris评分第3，6个月低于半髋置换组，但第12个月、2.5年的组间差异无显著性意义，可见内固定组与半髋置换组的Harris评分均随着时间的延长而升高，且2组间的差距随着时间的延长而不断接近，并于术后9个月即可达到相等。内固定组的SF-36评分由术后3个月的(68.5±3.6)分提高到术后 2.5年的(86.8±3.0)分，有统计学差异(P < 0.05)；半髋置换组SF-36评分由术后3个月的(74.2±3.3)分提高到术后2.5年(84.5±3.1)分，差异有显著性意义(P < 0.05 )。术后第3个月的SF-36评分均为内固定组低于半髋置换组，差异有显著性意义(P < 0.05)；第6，12个月及2.5年SF-36评分为2组间差异无显著性意义(P > 0.05)。虽然内固定组的SF-36评分第3月低于观察组，但第6，12个月及2.5年的组间差异无显著性意义，可见内固定组与半髋置换组的SF-36评分均随着时间的延长而升高，且内固定组与半髋置换组间的差距随着时间的延长而不断接近，并于第6个月即可达到相等，甚至有超过半髋置换组的趋势。 2.3 移位型(Garden Ⅲ、Garden Ⅳ型)股骨颈骨折进行不同手术方式的组间比较内固定组的死亡率为33.3%，半髋置换组间的死亡率为29.1%，2组间的死亡率差异无显著性意义(P > 0.05)；内固定中1例出现股骨头坏死，1例因骨折不愈合而进行了半髋置换术，半髋置换组1例因髋臼磨损进行了全髋置换术，两者间差异有显著性意义。 2.3.1 不同组间手术时间、术中出血量和住院时间的比较见图4及表4。 2.3.2 不同组间、不同时间的生活质量评分比较见图5，6及表5。内固定定组的Harris评分由术后3个月的(59.4±5.5)分提高到术后 2.5年的(83.6±4.2)分，差异有显著性意义(P < 0.05)；半髋置换组Harris评分由术后3个月(69.6±4.5)分提高到术后 2.5年(84.0±2.0)分，差异有显著性意义(P < 0.05)。术后第3，6，12个月的Harris 评分均为内固定组低于半髋置换组，且差异均有显著性意义(P < 0.05)，术后 2.5年，2组间差异无显著性意义(P > 0.05)。虽然内固定组的Harris评分第3，6，12个月低于半髋置换组，但术后2.5年的组间差异无显著性意义，可见内固定组与半髋置换组间的趋势为Harris评分均随着时间的延长而升高，且内固定组与半髋置换组间的差距随着时间的延长而不断接近，并于术后 2.5年达到相等。内固定组的SF-36评分由术后3个月(67.8±3.7)分提高到术后2.5年(84.8±2.8)分，差异有显著性意义(P < 0.05)；半髋置换组SF-36评分由术后3个月的(73.2±3.1)分提高到术后2.5年的 (85.9±3.2)分，差异有显著性意义(P < 0.05 )。术后第3，6，12个月的SF-36评分均为内固定组低于半髋置换组，差异有显著性意义(P < 0.05)；术后 2.5年的SF-36评分2组间差异无显著性意义(P > 0.05)。可见虽然内固定组的SF-36评分第3，6，12个月低于半髋置换组，但第2.5年2组间差异无显著性意义，可见内固定组与半髋置换组间的趋势为SF-36评分均随着时间的延长而升高，且内固定组与半髋置换组间的差距随着时间的延长而不断接近，并于术后2.5年达到相等。 2.4 不良事件无移位内固定组中，1例患者出现股骨头坏死，疼痛较重，行半髋关节置换。该患者骨折虽然没有移位，但合并系统性红斑狼疮10余年，长期服用激素，骨质明显疏松。移位内固定组中，l例患者术后3个月明确骨不连，改行半髋关节置换；1例患者出现股骨头坏死，疼痛较重，行半髋关节置换。移位半髋置换组中，1例患者既往存在髋关节疼痛，术前影像学未显示明显骨性关节炎，患者不同意一期行全髋关节置换，逐行半髋置换。术后患者活动量较大，术后5年出现髋臼磨损明显，疼痛加重，影响活动，改翻修为全髋置换。 "

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