Totalna artroplastika kuka za prelome vrata femura kao urgentna procedura
Sažetak
Uvod/Cilj. Totalna artroplastika kuka (total hip arthroplasty – THA) je jedna od najčešće primenjivanih metoda za lečenje preloma vrata femura (femoral neck fracture – FNF) kod starijih. Međutim, retki su podaci o ranoj primeni THA za FNF. Cilj ovog rada bio je da se utvrdi razlika u postoperativnim komplikacijama i funkcionalnom ishodu između urgentne i odložene THA nakon FNF. Metode. Ovom prospektivnom studijom obuhvaćena su 244 bolesnika kojima je izvedena THA nakon FNF u periodu od januara 2010. do januara 2013. U prvoj grupi, kod 41 bolesnika izvedena je THA u prvih 12 sati od prijema. Ukupno 203 bolesnika su operisana odloženo, od kojih je kod 162 bila potrebna dodatna korekcija komorbiditeta. Zbog toga je druga grupa sastavljena od bolesnika (n = 41) koji su mogli da budu operisani neposredno po prijemu, ali je operacija odlagana usled institucionalnih razloga. Praćeni su mortalitet, funkcionalni ishod, kardiološke i pulmološke komplikacije, dekubitusi, dislokacije, infekcije, dužina hospitalizacije i revizije. Rezultati. Nije bilo razlika u godinama starosti, polu, tipu implantata, mortalitetu niti komplikacijama. Utvrđene su razlike u dužini bolničkog lečenja [t (51.72) = -10.25, p < 0.001]. Bolesnici operisani u prvih 12 časova od prijema imali su značajno bolje skorove u sva tri vremena procene funkcionalnog ishoda: na otpustu, t (80) = 2.556, p < 0.012; nakon jednog meseca, (80) = 4.731, p < 0.001; i nakon tri meseca, t (80) = 5.908, p < 0.001. Zaključak. Metoda THA kao urgentna procedura za FNFs nije široko prihvaćen koncept. Naši nalazi pokazuju da rani operativni tretman ne pogoršava klinički ishod. Rezultati daju jasnu prednost ranoj THA kod bolesnika sa FNF.
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