60岁以上非移位股骨颈骨折，内固定还是关节置换？

对移位股骨颈骨折，内固定通常导致较多的并发症。但对于非移位股骨颈骨折，采用内固定或关节置换的并发症风险尚无定论。

针对上述问题，有学者进行了相关研究，以对比对老龄（＞60岁）非移位股骨颈骨折患者，采用内固定和关节置换在再手术率上是否存在差异？结果发表在2021.07 JOT期刊上。

Objective（目的）

比较老年股骨颈骨折非移位型和微小移位患者采用内固定治疗和人工关节置换治疗的结局。

[Objective: To compare the outcomes of elderly patients with nondisplaced and minimally displaced femoral neck fractures treated with internal fixation versus arthroplasty.]

Study selection（研究选择）

如果样本人群满足 (1) 60岁或以上；(2)有非移位或微小移位(Garden I型或II型)股骨颈骨折；以及(3)该研究比较了内固定和关节成形术，则纳入研究。仅包括英文文稿全文。主要结果是再次手术，次要结果包括死亡率、患者报告的结局、住院时间、感染和输血。

[Study selection: Studies were included if the sample population was (1) 60 years of age or older, (2) had nondisplaced or minimally displaced (Garden I or II) femoral neck fractures, and (3) if the study compared internal fixation versus arthroplasty. Only full-text English manuscripts were included. The primary outcome was reoperation. Secondary outcomes included mortality, patient-reported outcomes, length of hospital stay, infection, and blood transfusions.]

Data Synthesis（数据综合）

在1597篇确定的文章中，有4篇文稿符合纳入标准，共有579名患者(236名接受了半髋置换术，343名接受了内固定术)。与内固定治疗相比，关节成形术治疗的患者再次手术的风险显著降低[相对风险:0.30 (95%置信区间，0.16–0.55，P，0.01)]。两个治疗组的1年死亡率没有显著差异。

[Data Synthesis: Of the 1597 identified articles, 4 manuscripts met the eligibility criteria with a total of 579 patients (236 treated with hemiarthroplasty and 343 treated with internal fixation). Patients treated with arthroplasty had a significantly lower risk of reoperation when compared with those treated with internal fixation [relative risk: 0.30 (95% CI, 0.16–0.55, P , 0.01)]. There was no significant difference detected in 1-year mortality risk between the 2 treatment groups.]

表1：纳入文献的挑选

表2：纳入4篇文章患者的基本资料

表3：再手术原因分析

Conclusions（结论）

与内固定相比，对于无移位和微小移位的老年股骨颈骨折患者，采用半髋关节置换治疗可降低70%再次手术的风险。

[Conclusions: In elderly patients with nondisplaced and minimally displaced femoral neck fractures, treatment with hemiarthroplasty may reduce the relative risk of reoperation by 70% when compared with internal fixation.]

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