İntertrokanterik kırığı olan ileri yaş (seksen yaş ve üstü) hastalarda, proksimal femoral çivi ve hemiartroplasti sonuçlarının karşılaştırılması

Year 2021, , 17 - 21, 30.03.2021

Ali Şişman , Şevki Şavk Serdar Çepni

https://doi.org/10.25000/acem.800692

Abstract

Amaç: İntertrokanterik femur kırığı olgularının cerrahi tedavisinde en sık kullanılan iki yöntem proksimal femoral çivi (PFNA) ve hemiartroplastidir. Çalışmanın amacı ileri yaştaki (80 yaş üzeri) olgularda öncelikli tedavi seçimini belirlemektir.
Yöntemler: 2012 -2017 yılları arasında yaşı 80 ve üzerinde olan intertrokanterik femur kırığı nedeni ile hemiartroplasti ya da PFNA uygulanan hastalar retrospektif olarak incelendi. Ameliyat süreleri, ameliyat sonrası yoğun bakım ihtiyacı, Harris Kalça Skoru, ameliyat sonrası komplikasyonlar ve ilk bir yıl içindeki ölüm oranları karşılaştırıldı.
Bulgular: İntertrokanterik femur kırığı olan ve 80 yaşın üzerinde toplam 120 hasta değerlendirildi. Hastaların 43’ü (35,8) hemiartroplasti grubunda, 77’si (64,2) PFNA grubunda yer aldı. Her iki grup arasında ilk bir yıl içinde ölüm oranları, ameliyat sonrası yoğun bakım ihtiyacı, Harris Kalça Skoru ve ameliyat sonrası komplikasyonlar açısından anlamlı fark tespit edilmedi. Operasyon süresi PFNA grubunda medyan 45 dakika (çeyrekler arası açıklık 40-50) iken, hemiartroplasti grubunda medyan 80 dakika (çeyrekler arası açıklık 75-85) (p<0.001). Operasyon süresinin PFNA grubunda daha kısa olduğu görüldü.
Sonuç: İleri yaş olgularda, intertrokanterik kırık tedavisinde hemiartroplasti ve PFNA arasında ameliyat sonrası sonuçlarda ve ilk bir yıl içindeki ölüm oranları arasında anlamlı fark bulunamamıştır. Buna rağmen ameliyat süresinin daha kısa olması PFNA’nın bir avantajı olarak değerlendirilebilir.

Keywords

Femur intertrokanterik kırık, hemiartroplasti, proksimal femoral çivi

Comparison of proximal femoral nail and hemiarthroplasty outcomes in elderly (over 80 years old) patients with intertrochanteric fractures

Abstract

Aim: Proximal femoral nail (PFNA) and hemiarthroplasty are the two most frequently used methods in the surgical treatment of intertrochanteric femur fractures. The study aimed to determine the priority choice for surgical treatment in elderly patients (over 80 years old).
Methods: Patients treated for intertrochanteric femur fractures between 2012 and 2017 were retrospectively analyzed. Patients aged 80 years and over who were treated with hemiarthroplasty or PFNA were included in the study. Length of the operation, need for postoperative intensive care, Harris Hip Score, postoperative complications, and mortality rates in the first year were compared.
Results: A total of 120 patients with intertrochanteric femur fractures older than 80 years were evaluated. There were 43 patients (35.8) in the hemiarthroplasty group and 77 (64.2) in the PFNA group. No significant differences were found between the two groups in terms of mortality, need for postoperative intensive care, Harris Hip Score, and postoperative complications in the first year. While the median operation time was 45 minutes (IQR 40-50) in the PFNA group, it was 80 minutes (IQR 75-85) in the hemiarthroplasty group (p <0.001). The length of the operation was shorter in the PFNA group.
Conclusion: In elderly patients, there were no significant differences between the surgical treatment modalities as hemiarthroplasty and PFNA in treating intertrochanteric fractures considering the postoperative outcomes and mortality rates within the first year. However, shorter operation time might be an advantage of PFNA.

Keywords

Femoral intertrochanteric fracture, hemiarthroplasty, proximal femoral nail

References

• 1. Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, et al. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019;14:203.
• 2. Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989;71:1214–25.
• 3. Kesmezacar H, Oğüt T, Bilgili MG, Gökay S, Tenekecioğlu Y. [Treatment of intertrochanteric femur fractures in elderly patients: internal fixation or hemiarthroplasty]. Acta Orthop Traumatol Turc. 2005;39:287–94.
• 4. Sambandam SN, Chandrasekharan J, Mounasamy V, Mauffrey C. Intertrochanteric fractures: a review of fixation methods. Eur J Orthop Surg Traumatol. 2016;26:339–53.
• 5. Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J. 2017;99-B:128–33.
• 6. Fichman SG, Mäkinen TJ, Safir O, Vincent A, Lozano B, Kashigar A, et al. arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing. Int Orthop. 2016;40:15–20.
• 7. Kim SY, Kim YG, Hwang JK. Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:2186–92.
• 8. Green S, Moore T, Proano F. Bipolar Prosthetic Replacement for the Management of Unstable Intertrochanteric Hip Fractures in the Elderly. Clin Orthop Relat Res. 1987;224:169-77.
• 9. Kumar Gn K, Meena S, Kumar N V, S M, Raj Mk V. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: a prospective study. J Clin Diagn Res. 2013;7:1669–71.
• 10. Kayali C, Agus H, Ozluk S, Sanli C. Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty. J Orthop Surg. 2006;14:240–4.
• 11. Fahad S, Nawaz Khan MZ, Khattak MJ, Umer M, Hashmi P. Primary Proximal femur replacement for unstable osteoporotic intertrochanteric and subtrochanteric fractures in the elderly: A retrospective case series. Ann West Med Surg. 2019;44:94–7.
• 12. Parker MJ, Khan RJK, Crawford J, Pryor GA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. J Bone Joint Surg Br. 2002;84:1150–5.
• 13. Nie B, Wu D, Yang Z, Liu Q. Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly: A meta-analysis. Medicine. 2017;96:e7446.
• 14. Yoo JI, Ha YC, Lim JY, Kang H, Yoon BH, Kim H. Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis. J Korean Med Sci. 2017;32:858.
• 15. Esen E, Dur H, Ataoğlu MB, Ayanoğlu T, Turanlı S. Evaluation of proximal femoral nail-antirotation and cemented, bipolar hemiarthroplasty with calcar replacement in treatment of intertrochanteric femoral fractures in terms of mortality and morbidity ratios. Eklem Hastalik Cerrahisi. 2017;28:35–40.
• 16. Luo X, He S, Zeng D, Lin L, Li Q. Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: Case report. Int J Surg Case Rep. 2017;38:37–42.
• 17. Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44:623–33.
• 18. Huang J, Shi Y, Pan W, Wang Z, Dong Y, Bai Y, et al. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients. Sci Rep. 2020;10:4840. 19. Tan WL, Shi YX, Zhang JY, Tang CR, Guan QB, Tan JJ. Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more. Medicine. 2020;99:e21862.
• 20. Görmeli G, Gözükara H, Görmeli C, Karakaplan M, Korkmaz M, Diliçıkık U. Outcome of transtibial AperFix system in anterior cruciate ligament injuries. Indian J Orthop. 2015;49:150.
• 21. Li M, Wu L, Liu Y, Wang C. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res. 2014;9:139.
• 22. Prasad S H, Patil S N, Chandra P S, Fernando A C. Functional outcome of unstable intertrochanteric femur fracture in elderly osteoporotic patients treated by primary cemented bipolar hemiarthroplasty versus internal fixation with proximal femoral nailing. Int J Orthop Sci. 2017;3:321–5.