加拿大麦克马斯特大学Mohit Bhandari领导国际研究团队，探讨了全髋关节置换术或半髋关节置换术治疗髋部骨折的疗效。2019年9月26日，《新英格兰医学杂志》在线发表了这项成果。

全球范围内，髋部骨折是成年人致残的十大原因之一。对于移位型股骨颈骨折，全髋关节置换术与半髋关节置换术的疗效仍不确定。

研究组在10个国家的80个中心进行一项随机试验，共招募了1495名移位型股骨颈骨折患者，年龄均大于50岁，在骨折发生前，所有参与者均能独自行走。将其随机分组，其中718名行全髋关节置换术，723名行半髋关节置换术。采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分对患者的髋关节功能进行评估。

随访24个月后，全髋关节置换组中有57例（7.9%）患者需进行二次手术，半髋关节置换组中有60例（8.3%），风险比为0.95。全髋关节置换组中有34例（4.7%）患者发生髋关节不稳或脱位，半髋关节置换组中有17例（2.4%），风险比为2.00。全髋关节置换组的WOMAC评分显著优于半髋关节置换组。两组间死亡率相差不大，分别为14.3%和13.1%，全髋关节置换组中有300例（41.8%）患者发生严重不良反应，半髋关节置换组有265例（36.7%）。

对于之前可独立行走的移位型股骨颈骨折患者，接受全髋关节置换或半髋关节置换，二次手术的发生率没有显著差异。术后24个月，全髋关节置换术在功能和生活质量方面临床上略优于半髋关节置换术，但差异不显著。

附：英文原文

Title: Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

Author: The HEALTH Investigators*

Issue&Volume: 2019/09/26

Abstract: 

BACKGROUND
Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty.

METHODS
We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points.

RESULTS
The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P=0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P=0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty.

CONCLUSIONS
Among independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months.

DOI: 10.1056/NEJMoa1906190

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1906190