| Questions/purposes:We sought to compare internal fixation with hemiarthroplasty of the clinical efficacy in the treatment of elderly ’s femoral neck fractureMethods: we take a retrospective analysis of 148 old patients who treated in The First Hospit al of Dalian Medical University from January 2010 to December 2013. Eligible patients according to different fracture type and surgury divided into 4 groups.(1)non-displaced femoral neck fracture(GardenⅠ, GardenⅡ type): A1 group(Internal fixation)、B1 group(Hemiarthroplasty);(2)Displaced femoral neck fracture(Garden Ⅲ, Garden Ⅳ type): A2 group(Internal fixation)、B2 group(Hemiarthroplasty). The patients had taken the basic examination to evaluate their physical condition after admission and X-ray examination to clear the fracture fracture type. we choose the surgical approach after the discussion. The patients had taken the operation in continuous epidural anesthesia or under general anesthesia according to the situation. The internal fixation group use the three parallel screws or DHS. Hemiarthroplasty group use the bipolar hemiarthroplasty. Postoperative of the two groups had been encouraged early weight bearing and we follow up the patients after 6 weeks. Comparison of internal fixation and hemiarthroplasty in non-displaced(GardenⅠ, GardenⅡ type) and displaced(Garden Ⅲ, Garden Ⅳ type) femoral neck fracture of the operative time, the blood loss, the hospital stay and the postoperative quality of life(by use Harris hip score and SF- 36 to assess the postoperative quality of life after surgery in 3 months, 6 months, 12 months and last follow-up at an average of 2.5 years). Statistical analysis was performed by using SPSS20.0.Results:137 patients had been followed- up at a 92.6% rate from an average of 2.5 years(maximum 4 years and the shortest 1.5 years).Comparison of clinical data by age, sex, fracture type, etc between the two groups show no significant difference(P> 0.05). 1.Non-displaced femoral neck fracture(GardenⅠ, GardenⅡ type):the operative time、the blood loss、the hospital stay of the internal fixation group is 0.5±0.5h、64.3±22.3ml and5.1±1.9d.while hemiarthroplasty group is 1.8±0.6h、250.0±129.1ml、12.2±5.5d.the Internal fixation group were significantly better than the hemiarthroplasty group(P <0.05).The mean mortality of the groups was similar with 21.4% of the patients under going internal fixation and 30.8% of the patients undergoing hemiarthroplasty(P> 0.05).Reoperation rate of the internal fixation group in which one patient received the hemiarthroplasty for the femoral head necrosis is higher than hemiarthroplasty group in which nobody received reoperation. Both HHS and SF-36 were increased with time in fixation group and the hemiarthroplasty group, and the difference was statistically significant(P <0.05).HHS of The internal fixation group was lower than hemiarthroplasty group at 3 and 6 month after surgery(P <0.05).But at 12 months and last follow-up, there is no significant difference between two group(P> 0.05). SF-36 of The internal fixation group was lower than hemiarthroplasty group at 3 month after surgery(P <0.05).But there is no significant difference between two group afer 6 month(P> 0.05). 2.Displaced femoral neck fracture(Garden Ⅲ, Garden Ⅳ type): the operative time、the blood loss、the hospital stay of the internal fixation group is 0.7±0.3h、110.0±41.8ml、7.4±1.9d.while hemiarthroplasty group is 1.9±0.6h、237.9±102.3、12.0±4.6d.the Internal fixation group were significantly better than the hemiarthroplasty group(P <0.05). The mean mortality of the groups was similar with 33.3% of the patients under going internal fixation and 29.1% of the patients undergoing hemiarthroplasty(P> 0.05). Reoperation rate of the internal fixation group in which has two patients received the hemiarthroplasty for the femoral head necrosis and Nonunion of fracture was similar with hemiarthroplasty group in which one patient received THA for acetabular wear(P> 0.05). Both HHS and SF-36 were increased with time in fixation group and the hemiarthroplasty group and the difference was statistically significant(P <0.05).HHS of The internal fixation group was lower than hemiarthroplasty group at 3、6 and 12 month after surgery(P <0.05).But there is no significant difference between two group at last follow-up(P> 0.05). SF-36 of The internal fixation group was lower than hemiarthroplasty group at 3、6 and 12 month after surgery(P <0.05).But there is no significant difference between two group at last follow-up(P> 0.05).Conclusion: For the surgical treatment of femoral neck fractures, internal fixation which has higher reoperation rate、shorter operation time、simpler operation、less injury and retains its own shares bones has more advantages than hemiarthroplasty. With the development of technology and surgical techniques mature, internal fixation is also fully meet the needs of early postoperative ambulation to educe postoperative complications and reach same quality of life of hemiarthroplasty in 2.5 years after operation. Internal fixation which have more advantages than the past is effective surgery in treatment of femoral neck fracture of elderly. |
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