股骨颈骨折在老年人群中发病率较高且伴有较多的合并症和较高死亡率，医疗费用往往较贵。股骨颈骨折目前的主流方法是采用手术治疗，但何种手术方法最好仍然存在争议，在过去的十年间有很多作者研究了这一问题，临床试验、荟萃分析或是回顾性分析的资料显示对老年患者而言全髋关节置换（THA）可能优于半髋关节置换（HA），本研究的目的是最近十年股骨颈骨折的治疗是否发生了变化，以找出更多的循证医学证据支持进行全髋关节置换。

    美国国家医学统计中心每年进行国家医院出院调查统计（National Hospital Discharge Survey, NHDS），从非联邦医院抽查短期住院患者的出入院记录，从医学统计中心获取1998年～2008年十年间的统计资料进行分析。所有患者的第一诊断均为股骨颈骨折（ICD-9 码820.00, 820.01, 820.02, 820.03, 820.09, 820.08），接受了内固定治疗（CPT码7855, 7915, 7935）、半髋关节置换（CPT码 8152）或全髋置换（CPT码8151）手术的患者纳入研究对象。根据入院时间、患者年龄、医院规模和医院区域进行分组。按照入院时间分为三个阶段：第一期（1998～2001），第二期（2002～2004），第三期（2005～2008）；根据年龄分为四组：一组（<50岁），二组（50～64岁），三组（65～79岁），四组（>80岁）；根据医院规模分为两组：规模一（<500张床），规模二（>500张床）；根据医院所在美国的区域分为四个区：区域一（东北部），区域二（中西部），区域三（南部），区域四（西部）。数据用百分位数表示，计数资料采用卡方检验。

    统计分析全部数据。内固定患者为31%，半髋关节为63.8%，全髋关节为5.3%，统计十年的数据发现全髋关节置换的比例并无明显变化（P>0.7），而不同年龄组全髋关节置换比例差别显著，但65～79岁组和>80岁组无显著性差别（P<0.001），在50～64岁组中全髋置换的比例最高（8.1%），<50岁组全髋置换比例最低（4.0%）。<50岁组的全髋置换的比例从第二期（0.8%）到第三期（8.3%）有所上升（P<0.001）；50～64岁组也有所上升（4.0%～12.7%，P<0.001），但在65～79岁组和>80岁组则无明显差异。不同地区和不同规模的医院进行全髋置换的比例无显著性差异。

    本研究显示在最近的10年间，全髋关节置换的比例在患者一定年龄阶段有所增加，尽管近期的一些文献显示老年股骨颈骨折患者宜采用全髋关节置换，但10年间的手术资料统计没有显示>65岁股骨颈骨折患者的置换比例上升，在较年轻患者（<65岁）中全髋关节置换的比例在2002～2004年和2005～2008年期间有所上升。

 

emoral neck fractures are common and are associated with considerable morbidity, mortality, and cost. While they are nearly universally treated operatively, debate still exists regarding the preferred method of management. During the last 10 years, numerous studies, meta-analyses, and review articles have suggested the possible superiority of total hip arthoplasty (THA) over hemiarthroplasty (HA) in the elderly population. The purpose of this study was therefore to assess whether trends in management of femoral neck fractures had changed over the last decade in response to the building evidence in support of performing THA.
METHODS

The National Hospital Discharge Survey (NHDS), conducted annually by the National Center for Health Statistics, collects medical and demographic information from a sample of inpatient discharge records selected from a national probability sample of non-federal, short-stay hospitals. Data from the NHDS from 1998 to 2008 was obtained for this study. All individuals admitted with a primary diagnosis of a femoral neck fracture (ICD-9 codes 820.00, 820.01, 820.02, 820.03, 820.09, and 820.8) were selected. Those individuals who had undergone internal fixation (IF) (CPT codes 7855, 7915, and 7935), HA (CPT code 8152), and THA (CPT code 8151) were chosen as the population for this study. Patients were grouped by time period, age, hospital size, and region. Three time periods were analyzed: Period I (1998-2001), Period II (2002-2004), and Period III (2005-2008). Four age groups were analyzed: Group I (<50), Group II (50-64), Group III (65-79), Group IV (>80). Two hospital sizes were analyzed: Size I (<500 beds), Size II (>500 beds). Four regions were analyzed: Region I (Northeast), Region II (Midwest), Region III (South), Region IV (West). Data was assessed using percentiles and associations were examined using the chi squared test for independence.
RESULTS

Reviewing the entire sample, IF was performed 31%, HA 63.8%, and THA 5.3%. No significant change in the rate of THA was identified when analyzing the entire same over time (p > 0.7). When age subgroups were reviewed, rates of THA varied significantly between all age groups, except those 65-79 and >80 (P 0.001), with the highest rate among those 50-64 (8.1%) and the lowest among those < 50 (4.0%). An increase in the rate of THA from time period II to III was noted among those < 50 (0.8% to 8.3%, p < 0.001) and those 50-64 (4.0% to 12.7%, p < 0.001), but not in those 65-79 or >80. The rate of THA did not show any trends over time when reviewed based on hospital size or geographic region.
DISCUSSION AND CONCLUSION

This study showed an increased incidence of THA following femoral neck fracture in certain age groups over the last decade. Although recent literature has supported the use of THA for the treatment of femoral neck fractures in the elderly population, review of a national database failed to reveal a corresponding increase in THA rates in those individuals >65 in the past decade. However, the rate of THA in the younger cohorts (<65) showed an increase in incidence between 2002-2004 and 2005-2008.