Geriatrik Femur İntertrokanterik Kırıklarda Üç Farklı Fiksasyon Metodunun Erken Mortalite Oranlarının Karşılaştırılması

Abstract

Amaç: İleri yaştaki femur intertrokanterik kırıkların tedavisinde çeşitli seçenekler mevcuttur. Mevcut çalışma intrameduller çivi, sementli ve sementsiz hemiartroplasti (HA) seçeneklerinin postoperatif ilk 30 gündeki mortalite oranlarını karşılaştırmayı amaçlamaktadır. Ayrıca bu periyotta mortaliteyi etkileyen faktörlerin incelenmesi amaçlanmıştır.

Gereç ve Yöntemler: İntertrokanterik femur kırığı için 2012-2020 arasında intrameduller çivi (Grup 1), sementli HA (Grup 2) ve sementsiz HA (grup 3) uygulanan hastalar çalışmaya dahil edildi. Demografik verilerle birlikte ameliyat öncesi ve ameliyat sırasındaki değişkenler analiz edilerek üç grup arasında karşılaştırıldı. İlk 24 saat, 7 gün ve 30 gün içerisindeki mortalite oranları her üç grup arasında karşılaştırıldı. Ayrıca 30 günün sonunda sağ kalan hastalar ve ölen hastaların değişkenleri karşılaştırılarak mortaliteyi etkileyen faktörler incelendi.

Bulgular: Çalışmaya 526 hasta dahil edildi (194 erkek, 332 kadın; ortalama yaş: 82.71±6.92/yıl). Sementli ve ya sementsiz HA uygulanan hastalarda ilk 7 ve 30 gündeki mortalite oranı intramedüller çivi fiksasyonu yapılan hastalardan daha yüksekti (sırasıyla, p=0.022; 0.001). İlk 30 gün içerisinde kaybedilen hastaların sağkalanlara göre yaşı (p=0.00), komorbidite sayısı (p=0.015), cerrahiye kadar geçen süresi (p=0.05) ve cerrahi süresi (p=0.013) daha yüksekti.

Sonuç: Yaşlı intertrokanterik kırık hastalarında intramedullar tespit ilk seçenek olarak düşünülmelidir. Cerrahiye kadar geçen süre ve operasyon süresinin kısaltılması mortaliteyi azaltmak için önemlidir.

Keywords

• hemiarthroplasty
• İntertrokanterik kırık
• proksimal femur çivisi
• sement

EARLY POSTOPERATIVE MORTALITY RATES IN ELDERLY PATIENTS WITH INTERTROCHANTERIC FEMORAL FRACTURE: COMPARISON OF THREE FIXATION METHODS

Abstract

Objective: Several surgical options are available for the treatment of elderly intertrochanteric femoral fractures (IFF). This study aimed to compare the mortality rates in the first postoperative month between the intramedullary nail fixation (INF), cemented and cementless hemiarthroplasty (HA). Also, we aimed to analyze the factors that affect the mortality rates within the first postoperative month.

Material and Methods: Elderly patients who underwent INF (Group 1), cemented HA (Group 2), and cementless HA (Group 3) for IFF between 2012 and 2020 were selected for the study. Demographic data, pre, and perioperative variables were compared between the three treatment groups. The mortality rates in the first 24 h, 7 days, and 30 days were also compared as well. The patients were divided into survival and non-survival groups according to the outcome in the first postoperative month and factors affecting mortality rates were evaluated.

Results: A total of 526 patients were included in the study (194 men and 332 women; mean age, 82.71±6.92 years). The patients who received cemented or cementless HA had higher mortality rates on the first 7 days and 30 days after the operation than those treated with INF (p=0.022; 0.001, respectively). The patients who died within 30 days postoperatively were older (p=0.00) and had more comorbidities (p =0.015) and longer intervals from trauma to surgery (p=0.05) and operation times (p=0.013) than those who survived in the first postoperative month.

Conclusion: Intramedullary fixation should be the first option in elderly IFFs. The duration between trauma and surgery and operation time should be shortened to reduce mortality.

Keywords

• Hemiarthroplasty
• Intertrochanteric fracture
• proximal femoral nail
• cement

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