| Objective:To study the intraoperative and postoperative effects and costs of internal fixation (IF), hemiarthroplasty (HA) and total hip arthroplasty (THA) for the treatment of femoral neck fracture above65year-old population, so as to provide theoretic evidence and reference for decision making, as well as to provide the basis for the carry out about the three grade prevention and community health education of hip fractures.Methods:A retrospective survey was carried out in178above65year-old population in three level of first-class hospital in Hangzhou City about the clinical data of patients with femoral neck fractures for operation treatment from January2010to December2013, their operation time, amount of bleeding during operation and a follow-up research were recorded postoperatively. These cases were followed up by way of out-patient review, follow-up phone calls and home visits, the average follow-up period was30months (12-45months), and the purpose of follow-up is to find out the efficacy after operation. The follow-up contents include the hip joint function, health-related quality of life, and pain relief and complications rate. Finally, calculate the total cost of first hospitalization expenses and next hospitalization. The aspects of intra-operative conditions, postoperative follow-up and the hospitalization expenses were compared. The pros and cons of internal fixation, semi hip replacement, and total hip replacement were evaluated. SPSS19.0software was used for statistical analysis of these data.Results:(1) Intraoperative Data:The average duration of surgery was (42±10.9) min for the IF group,(68±12.4) min for the HA group and (96±17.2) min for the THA group. There were statistically significant differences among the three groups (P<0.001).The average intra-operative blood loss was (85±19.4) ml for the IF group,(172±21.6) ml for the HA group,(240±32.7) ml for the THA group, and the differences among the three groups were also statistically significant (P<0.001).(2) Follow-up Data:The average score (HHS) were (81.6±9.2),(84.3±11.6) and (90.2±7.7), respectively, for the IF group, HA group and THA group. There was a statistically significant difference between IF group and THA group (P=0.012), but there was no statistically significant difference neither between IF group and HA group(P=0.085) nor between HA group and THA group(P=0.217). The average score (SF-12) was (82.3±19.4) for the IF group,(86.2±21.6) for the HA group,(97.5±32.7) for the THA group. There was a statistically significant difference between THA group and IF group(P=0.002) and a statistically significant difference between THA group and HA group(P=0.008). But it was not statistically different between IF group and HA group(P=0.325). The average score (VAS) were (3.3±1.2),(2.4±1.6),(1.8±0.9) for the IF group, HA group and THA group. There was a statistically significant difference between THA group and IF Ⅲ Tongji University Master of Philosophy Abstract group(P=0.015). It was statistically different between HA group and IF group (P=0.037) too, but there was no statistical difference between THA group and HA group(P=0.082). The incidence rates of major method-related complications were35.2%,12.8%and89.1%for the IF group, HA group, THA group and respectively, the complication rate was higher than HA group and THA group, it was a statistically significant (P<0.001). but the difference between the HA and THA groups were not statistically significant(P=0.085). The rate of secondary operation was higher in the IF group(26.4%), compared with the HA group(8.9%, P<0.001). But there was no statistical difference neither between IF group and THA group (9.0%, P<0.001) nor between THA group and HA group (P=0.754).(3) Costs Data:The average initial hospital stay costs was (2356.2±1120.3) RMB in IF group,(38750.6±1524.2) RMB in HA group,(49122.5±2721.6) RMB in THA group. There were statistical differences among the three groups (P<0.001).The average of second hospital stay costs was (43298.2±4480.3) RMB in IF group,(57423.6±3767.4) RMB in HA group,(72140.5±6329.3) RMB in THA group. There were statistical differences among the three groups (P<0.001).Conclusion:The methods of operation treatment about femoral neck fracture consist of closed reduction and cannulated screw internal fixationin, artificial total hip replacement and artificial hip replacement etc.. For the above65year-old people with femoral neck fractures, internal fixation is associated with less initial operative trauma, but in the view of postoperative hip joint Harris score and VAS score for pain relief, it has poorer functional outcome and an increased risk of re-operation on the hip. On the contrary, arthroplasty is ideal but more invasive and expensive. Therefore, for elderly patients with femoral neck fractures, the patient physiological age, pre-injury physical condition, compliance and life expectancy and other factors dictate the choice of treatment. For the patients who have health problems are too frail to withstand the artificial hip replacement, internal fixation is the best choice. Although the internal fixation operation can’t let patients leave a sickbed in the short time, internal fixation operation can relieve the pain of the patients and solve the patients who have the problem in turning over the bed.For the elderly patients who can tolerant the joint replacement operation with cognitive impairment, poor ability of activities of daily living, older physiological age, and shorter life expectancy, hemiarthroplasty is recommended. It will be benefited from total hip arthroplasty for those patients with relatively younger phsiological age, good ability of daily living, independent living, good compliance and life expectancy of more than10years. |
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