Comparison of internal fixation and total hip replacement in elderly patients with femoral neck fractures / 中华老年医学杂志

ABSTRACT

Objective:To compare the clinical results and costs of treatment between internal fixation and total hip replacement in patients aged 60 to 75 years with femoral neck fractures, in order to provide a reference basis for choosing the appropriate surgical procedure for patients in this age group.Methods:According to the inclusion and exclusion criteria, we selected 69 patients treated with internal fixation and 88 patients treated with total hip replacement for femoral neck fractures, and collected relevant data to analyze the differences in clinical characteristics and prognosis between the two groups.Results:The total hip replacement group was older than the internal fixation group[68(64, 72) vs.63(61, 68), Z=-4.536, P<0.001]. There were 20 men(29.0%)and 49 women(71.0%)in the internal fixation group, and 13 men(14.8%)and 75 women(85.2%)in the total hip replacement group.Both groups had more women than men( χ2=4.706, P=0.030). The ratio of the displaced type to the non-displaced type was higher in the total hip replacement group than in the internal fixation group(90.9% vs.46.4%, χ2=37.510, P<0.001). Postoperative serum albumin levels were lower than preoperative levels in both groups, with greater decreases in the total hip replacement group than in the internal fixation group[(9.06±3.45)g/L vs.(7.07±3.37)g/L, t=-3.393, P=0.001]. The total hip replacement group had a higher intraoperative bleeding volume and blood transfusion volume than the internal fixation group( P<0.05), and the days of hospitalization[12(9, 14)d]and hospitalization costs[￥89222.1(84826.8, 93040.0)]were higher than those in the internal fixation group[9(8, 10)d; ￥51158.9(47816.5, 54098.4), Z=-5.138, -10.737, P<0.001 for both]. Weight-bearing after total hip replacement occurred earlier than the internal fixation group[32.0(28.0, 36.5)d vs.92.0(89.3, 95.5)d, Z=-10.228, P<0.001]. There were no significant differences between the two types of surgery for non-displaced femoral neck fractures at 1 year after surgery in the Harris hip score and the quality of life score EQ-5D.For patients with displacement, the rates of excellent and good outcomes based on the Harris score for the total hip replacement group were significantly higher than those for the internal fixation group at 1 year after surgery(97.5% vs.81.3%, χ2=6.697, P=0.010); the postoperative quality of life score EQ-5D was also better than that of the internal fixation group[0.9(0.7, 1.0) vs.1.0(1.0, 1.0), Z=-4.785, P<0.001], and the incidence of postoperative pain and anxiety was lower than that in the internal fixation group(6.3% vs.28.1%, 1.3%, vs.50.0%, χ2=7.928, 38.032, all P<0.01). Conclusions:The mortality and short-term postoperative complications between internal fixation and total hip replacement have no significant differences.There is no significant difference in postoperative function between the two surgical methods for patients with non-displaced femoral neck fractures.For patients with displacement, total hip arthroplasty is superior to internal fixation.The cost of initial hospitalization for internal fixation is significantly lower than for total hip replacement.