背景:由于衰老和骨质疏松症导致的股骨颈骨折全球增加是一项主要的临床挑战。关于股骨颈骨折最佳手术干预的争论仍未解决。这项大规模研究探讨了老年人的股骨颈骨折,重点是日本患者全髋关节置换术(THA)与双极半关节置换术(BHA)的比较结果。
方法:使用日本国家行政诊断程序组合(DPC)数据库,我们研究了2016年4月至2023年3月的股骨颈骨折病例,并在按年龄进行倾向评分匹配后,性别,和合并症,我们检查了THA,并发症,和临床结果,和THA对老年股骨颈骨折的有用性。
结果:一对一的倾向评分匹配确定了7741对THA和BHA病例。THA组和BHA组之间的住院时间没有差异。THA组需要更多的输血。THA和BHA组之间的死亡率没有显着差异,但是THA组的肺炎风险降低,比率为0.547(95%CI:0.418-0.715)。另一方面,THA组有更高的肺栓塞风险,比率为1.607(95%CI:1.379-1.874)。THA组显示出改善的出院率直接从进行手术的设施回家,比率为1.798(95%CI:1.675-1.929)。
结论:这项研究的结果表明,在使日本老年股骨颈骨折患者直接出院和预防肺炎方面,THA比BHA更有效,尽管担心肺栓塞。这些结果表明,THA可以改善老年股骨颈骨折患者的功能预后。尽管肺栓塞风险增加存在权衡。
BACKGROUND: The global increase in femoral neck fractures due to aging and osteoporosis is a major clinical challenge. The debate on the optimal surgical intervention for femoral neck fractures remains unresolved. This large-scale study explores femoral neck fractures among the elderly, focusing on the comparative outcomes of Total Hip Arthroplasty (THA) versus Bipolar Hemiarthroplasty (BHA) in Japanese patients.
METHODS: Using the Japanese National Administrative Diagnosis Procedure Combination (DPC) database, we studied cases of femoral neck fracture from April 2016 to March 2023, and after propensity score matching by age, sex, and comorbidities, we examined the association between THA, complications, and clinical outcomes, and the usefulness of THA for elderly patients with femoral neck fracture.
RESULTS: One-to-one propensity score matching identified 7741 pairs of THA and BHA cases. There was no difference in length of stay between the THA and BHA groups. Significantly more blood transfusions were required in the THA group. There was no significant difference in mortality between the THA and BHA groups, but there was a reduced risk of pneumonia in the THA group, with a ratio of 0.547 (95% CI: 0.418-0.715). On the other hand, the THA group had a higher risk of pulmonary embolism, with a ratio of 1.607 (95% CI: 1.379-1.874). The THA group shows improved discharge rates directly home from the facility where the operation was performed, with a ratio of 1.798 (95% CI: 1.675-1.929).
CONCLUSIONS: The findings of this research indicate that THA is more effective than BHA in enabling elderly Japanese patients with femoral neck fractures to be discharged directly home and in preventing pneumonia, despite concerns about pulmonary embolism. These findings suggest that THA may improve functional prognosis in elderly patients with femoral neck fractures, although there is a trade-off with an increased risk of pulmonary embolism.