Background: 

The optimal treatment of displaced femoral neck fractures in patients 55 to 70 years old remains controversial. The aim of the present study was to assess the effect of closed reduction and internal fixation with cannulated screws (IF) compared with total hip arthroplasty (THA) on hip pain and function, with use of data for outcome measures, complications, and reoperations.

Methods: 

This multicenter randomized controlled trial included all patients 55 to 70 years old who presented with a low-energy displaced femoral neck fracture between December 2013 and December 2018. Patients were randomly allocated to undergo either IF or THA. The primary outcome was the Harris Hip Score (HHS) at 12 months postoperatively. Secondary outcomes were the HHS at 4 and 24 months postoperatively, Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), health-related quality of life (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] index score and EQ-VAS [visual analogue scale]), VAS for pain, and VAS for patient satisfaction at 4, 12, and 24 months postoperatively. Complications and reoperations were continuously monitored. The primary analyses were performed according to the intention-to-treat principle.

Results: 

A total of 102 patients with a mean (± standard deviation) age of 63.7 ± 4.2 years were allocated to IF (n = 51) or THA (n = 51). The mean difference in the primary outcome, the HHS at 12 months postoperatively (5.3; 95% confidence interval, 0.9 to 9.7; p = 0.017), was below the predefined minimal clinically important difference of 10 points. However, patients who underwent THA had a significantly higher HHS at 4 and 12 months, better OHS at 4 and 12 months, and better HOOS at 4, 12, and 24 months postoperatively. Patients who underwent THA also reported better health-related quality of life at 4 months postoperatively and reported greater satisfaction and less pain at 4 and 12 months postoperatively. A total of 26 patients in the IF group (51%; 95% confidence interval, 37% to 65%) and 2 patients in the THA group (4%; 95% confidence interval, 0.5% to 13%) underwent a major reoperation.

Conclusions: 

In this randomized controlled trial, we showed that patients between 55 and 70 years old who underwent THA for a low-energy displaced femoral neck fracture experienced better outcomes than those who underwent closed reduction and internal fixation.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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55 至 70 岁患者低能量移位股骨颈骨折后全髋关节置换术带来更好的结果：一项比较内固定和全髋关节置换术的随机对照多中心试验

背景： 

对于 55 至 70 岁患者的移位股骨颈骨折的最佳治疗仍存在争议。本研究的目的是评估闭合复位和空心螺钉内固定（IF）与全髋关节置换术（THA）相比对髋关节疼痛和功能的影响，并使用结果测量、并发症和再手术的数据。

方法： 

这项多中心随机对照试验纳入了 2013 年 12 月至 2018 年 12 月期间出现低能量移位股骨颈骨折的所有 55 至 70 岁患者。患者被随机分配接受 IF 或 THA。主要结果是术后 12 个月的哈里斯髋关节评分 (HHS)。次要结局是术后 4 个月和 24 个月的 HHS、牛津髋关节评分 (OHS)、髋关节残疾和骨关节炎结局评分 (HOOS)、健康相关生活质量 (EQ-5D-3L [EuroQol 5 Dimensions 3 Levels] 指数评分和 EQ-VAS [视觉模拟量表]），VAS 表示疼痛，VAS 表示术后 4、12 和 24 个月的患者满意度。持续监测并发症和再次手术。主要分析是根据意向治疗原则进行的。

结果： 

共有 102 名平均（±标准差）年龄为 63.7 ± 4.2 岁的患者被分配到 IF（n = 51）或 THA（n = 51）。主要结果的平均差异，即术后 12 个月的 HHS（5.3；95% 置信区间，0.9 至 9.7；p = 0.017），低于预定义的最小临床重要差异 10 分。然而，接受 THA 的患者在 4 个月和 12 个月时 HHS 显着更高，在 4 和 12 个月时 OHS 更好，在术后 4、12 和 24 个月时 HOOS 更好。接受 THA 的患者在术后 4 个月也报告了更好的健康相关生活质量，并在术后 4 个月和 12 个月报告了更高的满意度和更少的疼痛。IF 组共有 26 例患者（51%；95% 置信区间，37% 至 65%），THA 组共有 2 例患者（4%；95% 置信区间，0.

结论： 

在这项随机对照试验中，我们发现 55 至 70 岁的低能量移位股骨颈骨折患者接受 THA 的结果优于接受闭合复位内固定的患者。

证据等级： 

治疗一级。有关证据级别的完整描述，请参见作者说明。