目的:主要目的是评估全髋关节置换术(THA)是否能够在髋关节囊内骨折后恢复与健康相关的生活质量(HRQoL)。次要目的是评估髋关节特定功能的变化,健身/虚弱,死亡风险,并发症和翻修风险,以及与这些因素独立相关的因素。
方法:这项回顾性队列研究包括42个月期间从急诊科收治的所有年龄≥50岁髋部骨折患者。患者人口统计学,围手术期变量,并发症,修订版,和死亡率被收集。在最后的随访中评估患者报告的结果指标(PROM)。
结果:在250名确定的患者中,189名女性(75.6%),平均年龄为70.3岁(50-94岁)。平均随访时间为2.3(SD1.1)年。植入物和患者2年生存率均为95.5%(95%置信区间(CI)+/-2.7)。年龄(风险比[HR]1.22,95%CI1.12-1.33,p<0.001)和男性(HR3.33,95%CI1.15-10.0,p=0.026)与死亡率独立相关。有19(7.6%)术后并发症,包括6(2.4%)假体周围骨折,5(2.0%)深部感染,和8(3.2%)脱位,其中13人进行了修订。增加手术时间(HR1.02,95%CI1.01-1.03,p=0.017)与术后并发症独立相关。166例(66.4%)患者术后可使用PROM。EuroQol-5D有显著(p<0.001)恶化(平均差[MD]0.192,95%CI0.133-0.252),牛津髋关节评分(MD2.5,95%CI1.5-3.6),和适应性(Rockwood评分MD0.7,95%CI0.5-0.8)相对于术前功能水平。
结论:THA可能是身体活动患者的首选治疗方法,目的是恢复他们的HRQoL,髋关节功能,和健身,但这没有被观察到。此外,并发症发生率很高,这与手术时间增加有关。
方法:III,回顾性队列研究。
OBJECTIVE: The primary aim was to assess whether a total hip arthroplasty (THA) was able to restore health-related quality of life (HRQoL) following an intracapsular hip fracture. The secondary aims were to assess changes in hip-specific
function, fitness/frailty, mortality risk, complications and revision risk, and factors independently associated with these.
METHODS: This retrospective cohort study included all patients aged ≥ 50 years admitted with a hip fracture from the emergency department at a single centre during a 42-month period. Patient demographics, perioperative variables, complications, revision, and mortality were collected. Patient-reported outcome measures (PROMs) were assessed at final follow-up.
RESULTS: Among 250 identified patients, 189 (75.6%) were women with a mean age of 70.3 (range 50-94 years). Mean follow-up was 2.3 (SD 1.1) years. The implant and patient survival rates at 2 years were both 95.5% (95% confidence intervals (CI) +/- 2.7). Older age (hazard ratio [HR] 1.22, 95% CI 1.12-1.33, p < 0.001) and male sex (HR 3.33, 95% CI 1.15-10.0, p = 0.026) were independently associated with mortality. There were 19 (7.6%) postoperative complications that included 6 (2.4%) periprosthetic fractures, 5 (2.0%) deep infections, and 8 (3.2%) dislocations, of which 13 underwent revision. Increasing time to theatre (HR 1.02, 95% CI 1.01-1.03, p = 0.017) was independently associated with a postoperative complication. Postoperative PROMs were available for 166 (66.4%) patients. There were significant (p < 0.001) deteriorations in EuroQol-5D (Mean difference [MD] 0.192, 95% CI 0.133-0.252), Oxford hip score (MD 2.5, 95% CI 1.5-3.6), and fitness (Rockwood score MD 0.7, 95% CI 0.5-0.8) relative to preoperative levels of
function.
CONCLUSIONS: THA may be the treatment of choice in a physically active patient with the aim of restoring their HRQoL, hip
function, and fitness, but this was not observed. Furthermore, there was a high complication rate which was associated with increasing time to theatre.
METHODS: III, retrospective cohort study.