İnstabil Femur İntertrokanterik Kırıklarında İki Farklı Tedavi Yönteminin Karşılaştırması

Abstract

Amaç: Geriatrik popülasyonda mortalite ve morbidite oranı yüksek klinik bir durum olan kalça kırığının cerrahi tedavisinde kullanılan iki farklı yöntem olan proksimal femoral çivi ve parsiyel kalça protezinin hastalarda perioperatif farklarının, klinik açıdan iyileştirici etkilerinin ve fonksiyonel sonuçlarının literatür verileriyle karşılaştırılması amaçlandı. Gereç ve Yöntem: Eylül 2019 - Eylül 2020 arasında Evans sınıflamasına göre instabil femur intertrokanterik kırığı olarak kabul edilen 73 hasta proksimal femoral çivi (grup 1) ya da parsiyel kalça protezi (grup 2) ile tedavi edildi. Çalışmaya dahil edilen hastalar; ek hastalıkları, vücut kitle indeksleri, anestezi şekilleri, American Society of Anesthesiologists değerleri, intraoperatif kanama, ameliyat olana kadar geçen süreleri, ameliyat sonrası hastanede kalış süreleri, Harris kalça skorları, derin ven trombozu, yara yeri enfeksiyonu gibi postoperatif komplikasyonları ve ölüm oranları açısından analiz edildi. Bulgular: Hasta grubu; yaşları 65-96 arasında olan 29 erkek ve 44 kadından oluşmaktaydı. Çalışmaya dahil edilen hastalar ortalama 8,2 ay takip edildi. Hastalara ameliyat sonrası 6.ay kontrollerinde Harris kalça skoru hesaplandı. Bu skor grup 1 hastalarda ortalama 72,10 puan ve grup 2 hastalarda ortalama 65,55 puandı (p=,24). Cerrahi prosedür bakımından pre-op süre, kan gereksinimi, Harris kalça skalası açısından anlamlı fark bulunamadı. Ancak hemiartroplasti lehine olarak operasyon sonrası hastanede kalış süresi anlamlı olarak uzamıştı (p=,02). Hastaların American Society of Anesthesiologists değeri açısından, düşük ve yüksek riskli hastalarda proksimal femoral çivi, orta riskli hastalarda hemiartroplasti tercih etme eğilimimiz istatistiksel olarak anlamlı bulundu (p=,01). Takip edilen 3 hastada yara yeri enfeksiyonu ve 2 hastada periprostetik kırık gelişti. Sonuç: İnstabil femur intertrokanterik kırıklarında hem proksimal femoral çivi hem de parsiyel kalça protezi iyi klinik ve fonksiyonel sonuçlar göstermektedir ve güvenle uygulanabilir yöntemlerdir.

Keywords

• Femur intertrokanterik kırık
• proksimal femur çivisi
• kalça hemiartroplastisi
• harris kalça skalası

Comparison of Two Different Treatment Methods in Unstable Femur Intertrochanteric Fractures

Abstract

Objective: We aimed to compare the perioperative differences, clinical curative effects and functional results of proximal femoral nail and partial hip prosthesis, which are two different methods used in the surgical treatment of hip fracture, which is a clinical condition with high mortality and morbidity rates in the geriatric population, with literature data. Material and Method: Between September 2019 and September 2020, 73 patients who were accepted as unstable femoral intertrochanteric fractures according to the Evans classification were treated with proximal femoral nail (group 1) or partial hip replacement (group 2). Patients included in the study were analyzed; in terms of comorbidities, body mass indexes, anesthesia types, American Society of Anesthesiologists values, intraoperative bleeding, time until surgery, postoperative hospital stay, Harris hip scores, deep vein thrombosis, wound infection, and mortality rates. Results: The patient group consisted of 29 men and 44 women aged 65-96 years. The patients included in the study were followed up for an average of 8.2 months. Harris hip score was calculated for the patients at the 6th month postoperative followup. This score was an average of 72.10 points in group 1 patients and 65.55 points in group 2 patients (p=.24). No significant difference was found in terms of pre-operative time, blood requirement, Harris hip scale for different surgical procedures. However, postoperative hospital stay was significantly longer in favor of hemiarthroplasty (p=.02). In terms of the patients' American Society of Anesthesiologists value, our tendency to prefer proximal femoral nail in low and high risk patients and hemiarthroplasty in moderate risk patients was found statistically significant (p=.01). Wound infection developed in 3 patients and periprosthetic fractures in 2 patients. Conclusion: In unstable femur intertrochanteric fractures, both proximal femoral nail and partial hip prosthesis show good clinical and functional results and are safely applicable methods.

Keywords

• Femoral intertrochanteric fracture
• proximal femoral nail
• hip hemiarthroplasty
• harris hipscale

References

1. Dinesh KD, Elaine MD, Nick CH, Cyrus C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011 Jan-Mar; 45(1): 15–22.
2. Schmidt AH, Swiontkowski MF. Femoral neck fractures. Orthop Clin North Am. 2002;33(1):97-111.
3. Carolyn B, Scott C, Jared T, Carter L, Don JM, William M et al. Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int. 2006;17(3):410-6.
4. Özgür K, Yıldıray G. Treatment of Intertrochanteric Femur Fractures in the Elderly via Bipolar Hip Arthroplasty or Proximal Femoral Nail. South. Clin. Ist. Euras. 2018;29(2):115-119.
5. Anıl A, Adem S, Orhan G, Deniz G, Cemil E. Comparison of Cementless Calcar-Replacement Hemiarthroplasty With Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures at Older Age Group. Cureus. 2021 Jan; 13(1): e12854.
6. Xiangping L, Shengmao H, Dingshi Z, Lijun L, Qi L. Proximal femoral nail antirotation versus hemiarthroplasty in the treatment of senile intertrochanteric fractures: case report. Int J Surg Case Rep. 2017;38:37-42.
7. Engin ED, Yunus İ, Murat E, Özlem A. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly. Clin Invest Med. 2015 Apr 8;38(2):E63- 72.
8. Gökay G, Mehmet FK, Cemile AG, Cihan A, Turgay K, Sezai AŞ. Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems. Ulus Travma Acil Cerrahi Derg. 2015;21(6):503–508.

9. Hasan G, Sinan C , Nedim K. Comparison of treatment of unstable intertrochanteric fracture with different arthroplasty methods Niger Med J Mar-Apr 2016;57(2):81-5.
10. Jensen JS, Michaelsen M. Trochanteric femoral fractures treated with McLaughlin osteosynthesis. ActaOrthopScand. 1975;46:795–803.
11. Rowe SM, Yoon TR, Kim YS, Lee GH. Hemovac drainage after hip arthroplasty. Int Orthop. 1993;17(4):238-40.
12. Gerard PS, Kelly AL, Savvas N, Peter JO. A systematic review of thromboprophylaxis for pelvic and acetabular fractures. J OrthopTrauma. 2009;23(5):379-84.
13. Kim EW, Inger NS, Rudolf WP, Mohit B, Daniël H. The Harris hipscore: do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010 Dec;81(6):703-7.
14. Doyle DJ, Goyal A, Bansal P, Garmon EH. American Society of Anesthesiologists Classification. Stat Pearls Publishing; 2021 Jan.2020 Jul 4. 28722969.
15. Uzun M, Ertürer E, Oztürk I, Akman S, Seçkin F, Ozçelik IB. Longterm radiographic complications following treatment of unstable intertrochanteric femoral fractures with the proximal femoral nail and effects on functional results. Acta Orthop Traumatol Turc. 2009;43(6):457- 63.
16. Bhandari M, Devereaux PJ, Swiontkowski MF, Paul T3, William O, Kenneth J K et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003 Sep;85(9):1673-81.
17. Lindskog DM, Baumgaertner MRJ. Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg. May-Jun 2004;12(3):179- 90.
18. 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 Nov;(224):169-77.
19. Bonnevialle P, Saragaglia D, Ehlinger, Tonetti J, Maisse N, Adam P, et al. Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years. Orthop Traumatol Surg Res. 2011 Oct;97(6 Suppl):S95-100.
20. Angad J, Rahul B, Avadut RM, Manikanta BP. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. 2019 Mar-Apr; 10(2): 296–301.
21. Liang YT, Tang PF, Guo YZ, Sheng T, Qun Z, Xiang-dang L, et al. Clinical research of hemiprosthesis arthroplasty for thetreatment of unstable intertrochanteric fractures in elderly patients. Zhonghua Yi Xue Za Zhi. 2005;85:3260–3262.
22. Grimsrud C, Monzon RJ, Richman J, Ries MD. Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures. J Arthroplast. 2005;20:337–343
23. Vochteloo AJ, Borgervan der BBL, Mertens BJ, Arthur HPN, Mark RV, Wim ET et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patient. BMC Musculoskelet Disord 2011; 12(1): 262. 19
24. Costain DJ, Whitehouse SL, Pratt NL, Stephen EG, Philip R, Ross WC et al. Perioperative mortality after hemiarthroplasty related to fixation method. Acta Orthop 2011; 82(3): 275–281. 20.
25. 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 SurgAm. 2005 Oct;87(10):2186-92.
26. Ucpunar H, Camurcu Y, Çöbden A, Sofu H, Kis M, Demirel H. Comparative evaluation of postoperative health status and functional outcome in patients treated with either proximal femoral nail or hemiarthroplasty for unstable intertrochanteric fracture. J Orthop Surg (Hong Kong). Sep-Dec 2019;27(3):2309499019864426.