The Clinical Efficacy Comparative Study Of Internal Fixation With Arthroplasty In Patients Older Than60Years With Femoral Neck

Objective:To explore a suitable operation method for femoral neck fracture in patients older than60years through observing the hip function of the femoral neck fracture(FNF), treated by internal fixation(IF), hemi-arthroplasty(HA) or total hip replacement (THR).Methods:The clinical information of patients with FNF in elderly were collected, who were treated by IF, HA or THR form January2008to December2010at Wuhan General Hospital of Guangzhou Command. The objects of the study were selected based on inclusion criteria and exclusion criteria. For all patients included in the study within the scope of regular follow-up, mainly for symptoms, signs and imaging data. All the cases were took X-ray radiography such as pelvic anteroposterior, anteroposterior and lateral of the hip preoperative and postoperative. Based on these X-ray radiography, the quality of the reduction evaluated by Garden Index, meanwhile patients treated with arthroplasty measured by Delee-Charnley Zones. The functional results were scored with the Harris Scoring System. The duration of surgery, length of hospitalization, complications, postoperative Harris hip score, and reoperation rate were recorded, and statistically analyzed between them.Results:According to the inclusion criteria and exclusion criteria,105cases of complete clinical data were selected from427surgical treatment of FNF in elderly cases since January2008to December2010. On the base of Garden classification system, there were28type â… ,35type â…¡,24type â…¢ and18type â…£. And24cases were fixed with three cannulated screws,9patients treated by DHS combined with an anti-rotation screw,33patients took by HA, and39patients by THR. All patients were followed up form18to4years (mean28months).In average, higher blood loss, increased surgical time and length of hospitalization happended in cases of the arthroplasty compared to patients treated with IF. AVN occurred in4cases and2patients became nonunion in the group IF. While in the arthroplasty group, dislocation appeared in3cases and prosthesis loosen in2patients. The Harris hip score was significantly higher in group B at the3,6, and12-month follow-up evaluations; however, the differences were no longer significant at the24-month evaluation.Conclusion:IF, HA and THR are all effective measures for FNF in elderly. But each has its advantages and disadvantages. In generally, un-displaced FNF prefer to use IF, whereas displaced FNF in elderly will be treated with arthroplasty.Primary hemiarthroplasty are preferentially performed in older patients with limited life expectancy and low functional demands.