PDF(Pubmed)
Abstract：
Hemiarthroplasty (HA) is the usual treatment for displaced femoral neck fractures (FNF) in elderly patients. Patients may be unsuitable for HA due to secondary conditions such as systemic infections or severe neurological conditions, which is why Girdlestone resection arthroplasty (GRA) may be an option. We aimed to determine (1) patient survival in matched patient groups treated with either GRA or HA and (2) functional outcomes.
21 patients treated with GRA for FNF in a German university hospital were retrospectively reviewed (2015-2019). After matching for age and comorbidities, a control group of 42 HA patients was established. Patient survival was determined by a Kaplan-Meier analysis. The mean follow-up (FU) was 1.5 (0-4.4) years. Function at FU was documented using the modified Harris Hip Score (mHHS) and the National Hip Fracture Database (NHFD) mobility score.
The 1-month-mortality was 19% in the GRA group and 12% in the HA group; the 1-year mortality was 71% and 49%, respectively (P = 0.01). The mHHS at FU was lower in the GRA group than in the HA group (22 [range 0-50] vs. 46 [11-80]). 82% of patients in the GRA group were bedridden post-surgery as opposed to 19% in the HA group.
Patients with HA after FNF had higher survival and better functional outcomes when compared with GRA in matched patient groups. Considering this, GRA for FNF should be selected restrictively.
21 patients treated with GRA for FNF in a German university hospital were retrospectively reviewed (2015-2019). After matching for age and comorbidities, a control group of 42 HA patients was established. Patient survival was determined by a Kaplan-Meier analysis. The mean follow-up (FU) was 1.5 (0-4.4) years. Function at FU was documented using the modified Harris Hip Score (mHHS) and the National Hip Fracture Database (NHFD) mobility score.
The 1-month-mortality was 19% in the GRA group and 12% in the HA group; the 1-year mortality was 71% and 49%, respectively (P = 0.01). The mHHS at FU was lower in the GRA group than in the HA group (22 [range 0-50] vs. 46 [11-80]). 82% of patients in the GRA group were bedridden post-surgery as opposed to 19% in the HA group.
Patients with HA after FNF had higher survival and better functional outcomes when compared with GRA in matched patient groups. Considering this, GRA for FNF should be selected restrictively.
摘要：
目的：人工股骨头置换术（HA）是老年患者移位股骨颈骨折（FNF）的常用治疗方法。患者可能因全身感染或严重的神经系统疾病等继发性疾病而不适合使用HA，这就是为什么Girdlestone切除关节成形术（GRA）可能是一种选择。我们旨在确定（1）使用GRA或HA治疗的匹配患者组中的患者生存率和（2）功能结局。
方法：回顾性分析了德国大学医院接受GRA治疗FNF的21例患者（2015-2019年）。在匹配了年龄和合并症之后，建立了42例HA患者的对照组。通过Kaplan-Meier分析确定患者的存活率。平均随访时间（FU）为1.5（0-4.4）年。使用改良的Harris髋关节评分（mHHS）和国家髋部骨折数据库（NHFD）移动性评分记录FU的功能。
结果：GRA组的1个月死亡率为19％，HA组为12％；1年死亡率为71％和49％，分别为(P=0.01)。GRA组FU的mHHS低于HA组（22[范围0-50]vs.46[11-80]).GRA组82％的患者在手术后卧床不起，而HA组为19％。
结论：在匹配的患者组中，与GRA相比，FNF术后的HA患者具有更高的生存率和更好的功能结局。考虑到这一点,应当限制性地选择FNF的GRA。
方法：回顾性分析了德国大学医院接受GRA治疗FNF的21例患者（2015-2019年）。在匹配了年龄和合并症之后，建立了42例HA患者的对照组。通过Kaplan-Meier分析确定患者的存活率。平均随访时间（FU）为1.5（0-4.4）年。使用改良的Harris髋关节评分（mHHS）和国家髋部骨折数据库（NHFD）移动性评分记录FU的功能。
结果：GRA组的1个月死亡率为19％，HA组为12％；1年死亡率为71％和49％，分别为(P=0.01)。GRA组FU的mHHS低于HA组（22[范围0-50]vs.46[11-80]).GRA组82％的患者在手术后卧床不起，而HA组为19％。
结论：在匹配的患者组中，与GRA相比，FNF术后的HA患者具有更高的生存率和更好的功能结局。考虑到这一点,应当限制性地选择FNF的GRA。
