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人工全髋关节置换术与人工股骨头置换术治疗髋部骨折的比较
Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture


The HEALTH Investigators* 其他 • 2019.12.05
NEJM 动画解读

髋部骨折手术方式的比较
相关阅读
• 髋部骨折发病率下降的原因是什么 • 人工股骨头置换术与人工全髋关节置换术治疗移位型股骨颈骨折的比较

“人生的最后一次”骨折,应该如何治疗

 

田华

北京大学第三医院骨科

 

髋部骨折好发于老年人,其危害严重。它不仅给患者带来巨大痛苦,也可因为随之而来的并发症,如坠积性肺炎、泌尿系感染以及深静脉血栓等而导致死亡。LeBlanc等报道髋部骨折后1年内的死亡率高达12%~17%,因此髋部骨折也常常被称为人生最后一次骨折[1]

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摘要


背景

在全球范围内,髋部骨折是导致成人残疾的十大原因之一。对于移位型股骨颈骨折,人工全髋关节置换术与人工股骨头置换术的效果比较仍未明确。

 

方法

我们将1,495例患移位型股骨颈骨折的≥50岁患者随机分组,分别接受人工全髋关节置换术或人工股骨头置换术。本试验纳入的所有患者在骨折发生之前均可无需他人协助而独立行走。本试验在10个国家的80个研究中心进行。主要终点是24个月随访期间的二次髋关节手术。次要终点包括死亡、严重不良事件、髋关节相关并发症、健康相关生活质量、功能和总体健康终点。

 

结果

全髋关节置换术组718例患者中的57例(7.9%)和股骨头置换术组723例患者中的60例(8.3%)发生了主要终点(风险比,0.95;95%置信区间[CI],0.64~1.40;P=0.79)。全髋关节置换术组34例患者(4.7%)和股骨头置换术组17例患者(2.4%)发生了髋关节不稳定或脱位(风险比,2.00;99% CI,0.97~4.09)。全髋关节置换术组的功能(用西安大略大学和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)总分、疼痛评分、僵直评分和功能评分进行测定)略优于股骨头置换术组。两个治疗组的死亡率相似(全髋关节置换术组14.3%和股骨头置换术组13.1%,P=0.48)。全髋关节置换术组300例患者(41.8%)和股骨头置换术265例患者(36.7%)发生了严重不良事件。

 

结论

在发生移位型股骨颈骨折,且骨折前可独立行走的患者中,在24个月期间,全髋关节置换术组和股骨头置换术组的二次手术发生率无显著差异。此外,全髋关节置换术与股骨头置换术相比使患者的功能和生活质量改善,但不具有临床意义(由加拿大卫生研究院[Canadian Institutes of Health Research]等资助;在ClinicalTrials.gov注册号为NCT00556842)。





作者信息

The HEALTH Investigators*
The affiliations of the members of the writing committee are as follows: the Division of Orthopaedic Surgery, Department of Surgery (M.B., S.S., S.B.), the Department of Health Research Methods, Evidence, and Impact (M.B., G.G., S.S., D.H.-A., L.T., S.D.W., P.J.D.), the Department of Medicine (G.G., P.J.D.), and the Population Health Research Institute (P.J.D.), McMaster University, Hamilton, and the Department of Surgery, University of Western Ontario, London (E.H.S.) — all in Ontario, Canada; the Department of Orthopedic Surgery, New York University Langone Medical Center, New York (T.A.E.); the Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans (R.D.Z.); the Division of Orthopedic Surgery, Oslo University Hospital, Oslo (F.F.); the Department of Traumatology, Orthopedic Surgery, and Emergency, Hospital Vall d’Hebrón, Barcelona (E.G.-F.); the Department of Orthopedic and Trauma Surgery, Deventer Ziekenhuis, Deventer (Y.V.K.), and the Department of Orthopedic Surgery, OLVG, Amsterdam (R.W.P.) — both in the Netherlands; and the Department of Orthopaedic Surgery, James Cook University Hospital, Middlesbrough, the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, and the Department of Health Sciences, University of York, York — all in the United Kingdom (A.R.). Address reprint requests to Dr. Bhandari at the Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street N., Suite 110, Hamilton, ON L8L 8E7, Canada, or at bhandam@mcmaster.ca. *A complete list of members of the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) Investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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