Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial
Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial
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DOI：
10.1136/bmj.39399.456551.25
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发表时间：
2007-12-15
影响因子：
105.7
通讯作者：
Madsen, Jan Erik
中科院分区：
文献类型：
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作者：
Frihagen, Frede;Nordsletten, Lars;Madsen, Jan Erik
目的比较股骨颈骨折移位后内固定或半髋关节置换术治疗的功能结果。设计随机试验与功能结果的盲法评估。设置大学医院。参与者222例; 165（74%）女性，平均年龄83岁。入选标准为年龄在60岁以上，骨折前有行走能力，无主要髋关节病变，无论认知功能如何。干预闭合复位和两个平行螺钉（112例）和双极骨水泥半髋关节置换术（110例）。随访4个月、12个月和24个月，主要结果测量髋关节功能（Harris髋关节评分）、健康相关生活质量（Eq-5d）、日常生活活动（Barthel指数）。结果半髋关节置换术组平均Harris髋关节评分在4个月时高8.2分（95%可信区间2.8 ~ 13.5分，P=0.003），在12个月时高6.7分（1.5 ~ 11.9分，P=0.01）。半髋关节置换术组24个月时的平均Eq-5d指数评分高出0.13（0.01至0.25，P=0.03）。4个月后，半髋关节置换术组的Eq-5d视觉模拟量表评分高出8.7分（1.9至15.6，P=0.01）。12个月和24个月后，半髋关节置换术组Barthel指数评分95或100的百分比较高（相对风险0.67，0.47至0.95，P=0.02）。0.63、0.42 ~ 0.94，P=0.02）。并发症发生率内固定组56例（50%），半髋关节置换组16例（15%）（3.44，2.11 ~ 5.60，P
Objective To compare the functional results after displaced fractures of the femoral neck treated with internal fixation or hemiarthroplasty.Design Randomised trial with blinding of assessments of functional results.Setting University hospital.Participants 222 patients; 165 (74%) women, mean age 83 years. Inclusion criteria were age above 60, ability to walk before the fracture, and no major hip pathology, regardless of cognitive function.Interventions Closed reduction and two parallel screws (112 patients) and-bipolar cemented hemiarthroplasty (110 patients). Follow-up at 4, 12, and 24 months.Main outcome measures Hip function (Harris hip score), health related quality of life (Eq-5d), activities of daily living (Barthel index). In all cases high scores indicate better function.Results Mean Harris hip score in the hemiarthroplasty group was 8.2 points higher (95% confidence interval 2.8 to 13.5 points, P=0.003) at four months and 6.7 points (1.5 to 11.9 points,P=0.01) higher at 12 months. Mean Eq-5d index score at 24 months was 0.13 higher in the hemiarthroplasty group (0.01 to 0.25, P=0.03). The Eq-5d visual analogue scale was 8.7 points higher in the hemiarthroplasty group after 4 months (1.9 to 15.6, P=0.01). After 12 and 24 months the percentage scoring 95 or 100 on the Barthel index was higher in the hemiarthroplasty group (relative risk 0.67, 0.47 to 0.95, P=0.02. and 0.63, 0.42 to 0.94, P=0.02, respectively). Complications occurred in 56 (50%) patients in the internal fixation group and 16 (15%) in the hemiarthroplasty group (3.44, 2.11 to 5.60, P