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

Öz

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.

Anahtar Kelimeler

• 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

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