九十岁以上的股骨颈骨折患者的中长期生存： 关节置换术与非手术治疗的比较

来源：304关节学术

Long-term Survival of Femoral Neck Fracture Patients Aged Over Ninety Years: Arthroplasty Compared With Nonoperative Treatment

九十岁以上的股骨颈骨折患者的中长期生存：

关节置换术与非手术治疗的比较

译者：罗殿中

Background: The aging of the Chinese population is expected to lead to an increase in nonagenarians and centenarians. The mortality rate in nonagenarian hip fracture patients is equivalent to the mortality rate in the average population at 5 years after injury. It is imperative to evaluate 5-year mortality in this small but very challenging subgroup of patients to optimize patient management. The primary purpose of the current retrospective study was to compare five-year survival in patients aged over 90 years who received arthroplasty or nonoperative treatment for femoral neck fracture during a 16-year period.

背景：预计中国人口的老龄化加重，90及100岁以上的老人数量会持续增多。90岁以上髋部骨折的死亡率与平将人口受伤5年后的死亡率相当。必须评估这一小群但又极具挑战性的患者伤后5年死亡率，进而最优化患者管理。本回顾性研究的主要目的是比较持续16年间90岁以上接受置换术或非手术治疗的股骨颈骨折患者在5年生存率。

Methods: From January 1998 to December 2014, all consecutive nonagenarian and centenarian patients with femoral neck fracture admitted to our hospital were included in the evaluation. The primary outcome was defined as thirty-day, 1-year, 3-year, and 5-year mortality after injury. Survival analysis was performed with the Kaplan-Meier method. Using the log-rank test, stratified analyses were performed to compare differences in the overall cumulative mortality and mortality at three time points (1 year, 3 years, and 5 years) after injury and differences in survival distributions.

方法：自1998年1月至2014年12月，对本院连续收治的所有90岁以上股骨颈骨折患者进行回顾分析。主要预后指标为受伤后30天、1年、3年和5年的死亡率。采用Kaplan-Meier生存分析评估生存率。使用对数秩检验及分层分析以比较总体累计死亡率和受伤后三个时间点（1年，3年和5年）的死亡率和生存分布的差异。

Results: Over the 16-year study period, the arthroplasty group and the nonoperative treatment group included 33 and 53 patients, respectively. The long-term survival probability of the arthroplasty group was significantly higher than that of the nonoperative treatment group (p = 0.002). The survival time of the arthroplasty group was significantly higher than that of the nonoperative treatment group (median (P75-P25) = 53 (59) versus median (P75-P25) = 22 (52), p = 0.001). The mortality differences, except for 30-day mortality, at five time points (1, 2, 3, 4, and 5 years) between the nonoperative group and arthroplasty group were significant. The stratified analyses of overall cumulative mortality and mortality at three time points (1, 3, and 5 years) after injury demonstrated that the nonoperative treatment group had significantly higher cumulative mortality than the arthroplasty group.

结果：在16年的研究期内，关节置换组和非手术治疗组分别纳入33例和53例患者。关节置换组的长期存活率显着高于非手术治疗组（p = 0.002）。关节置换组的生存时间明显高于非手术治疗组（中位数（P75-P25）= 53（59）vs中位数（P75-P25）= 22（52），p = 0.001）。非手术组和关节置换组在五个时间点（1、2、3、4和5年）的死亡率存在统计学差异，但伤后30天死亡率无差异。对总体累计死亡率和受伤后三个时间点（1、3和5年）的死亡率进行的分层分析表明，非手术治疗组的累计死亡率显着高于人工关节置换组。

Conclusions: Our study demonstrates that arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. It can be expected that nearly half of patients will survive more than 5 years after surgery.

结论：我们的研究表明，与非手术治疗相比，人工关节置换术更可能改善90岁以上的股骨颈骨折患者的中长期生存率。预计将近一半的患者在手术后存活时间超过5年。

文献出处：Liu Y, Zhang CW, Zhao XD. Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskelet Disord. 2020;21(1):217. Published 2020 Apr 8. doi:10.1186/s12891-020-03249-7