Comparison Of Two Surgical Approaches For Treatment Of Femoral Neck Fractures In Patients Aged 60 To 75 Years

Objective : To compare the clinical effect and cost of total hip arthroplasty and internal fixation in patients aged 60 to 75 years with femoral neck fracture,and provide reference for the patients in this age group to choose the appropriate operation method.Method : Patients aged 60 to 75 years old with femoral neck fracture who were hospitalized in Tian Jin hospital from January 1,2018 to December 31,2018 were selected.The final cases that met the criterion were 69 cases in the internal fixation group and 88 cases in the total hip arthroplasty group.We collected patients’ general information,the hospital information,operation information,hospitalization expenses,and the follow-up data.SPSS26.0 was used for statistical analysis.Results:(1)The age of the total hip arthroplasty group was older than the internal fixation group,and the proportion of women in both groups was more than men.There was a statistically significant difference in the ratio of displaced type/displaced type between the two groups;(2)The most common complication in both groups was osteoporosis.The morbidity of osteoporosis in the total hip arthroplasty group(93.18%)was higher than internal fixation group(82.61%).The morbidity of DVT in the total hip arthroplasty group(38.64%)was higher than internal fixation group(18.84%).The reduce of the postoperative serum albumin in the total hip arthroplasty group was lower;(3)The total length of hospital stay in the total hip arthroplasty group was longer.There was no statistically significant difference in the length of pre-operative hospital stay.The length of postoperative hospital stay in the total hip arthroplasty group was longer;(3)The intraoperative blood loss and blood transfusion in the total hip arthroplasty group were both more than internal fixation group.The difference in ASA grade and NNIS classification between the two groups was statistically significant;(4)Total hospitalization expenses of the total hip arthroplasty group were higher than internal fixation group.The consumables expenses,treatment expenses,comprehensive service fees were higher than the internal fixation group;(5)There were no statistically significant differences in mortality,readmission rate,complication rate and systemic complication ratebetween the internal fixation group and the total hip arthroplasty group;(6)The postoperative loading time of the total hip arthroplasty group was earlier than internal fixation group.There was no significant difference in hip function score(HHS)at 1year after surgery.Life quality score in the total hip arthroplasty group was higher than internal fixation group.There was no statistically significant difference between the two groups in action,self-care and daily activities,and the incidence of pain and anxiety after total hip arthroplasty was lower than internal fixation group;(7)In the internal fixation group,the loading time of the non-displaced group was earlier than displaced group.Postoperative hip function score(HHS),the excellent and good rate of non-displaced type was better than that of displaced type.There was no significant difference of life quality score EQ-5D between the two groups;(8)Comparing the internal fixation and total hip arthroplasty treating displaced femoral neck fracture,there was no statistically significant differences in readmission rate,complication rate between the two groups.The excellent and good rate of HHS score was higher in total hip arthroplasty(97.47%)than internal fixation(81.25%).Eq-5D score of total hip arthroplasty was superior to internal fixation.There was no statistically significant difference in mobility,self-care,and daily activities between the two groups,and the incidence of pain and anxiety after total hip arthroplaty was lower than internal fixation group.Conclusion:(1)There was no significant difference in mortality and short-term postoperative complications between internal fixation and total hip arthroplasty.(2)Regardless of fracture type,there was no significant difference in postoperative hip function between internal fixation and total hip arthroplasty.(3)The outcome of internal fixation treating non-displaced femoral neck fracture is better than that of displaced femoral neck fracture.(4)For patients with displaced femoral neck fractures,total hip replacement is superior to internal fixation in short-term improvement of hip function and quality of life.(5)The hospitalization expenses of internal fixation is significantly less than total hip arthroplasty.