Schoenfeld Andrew J, Leeson Mark C, Vrabec Gregory A, Scaglione Joseph, Stonestreet Matthew J
Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Akron, OH 44302, USA.
Int J Surg. 2008 Apr;6(2):140-6. doi: 10.1016/j.ijsu.2008.01.009. Epub 2008 Feb 6.
The treatment of complex femur fractures poses a significant challenge. Even with current advancements and the various implements available for the fixation of femoral fractures, results are often disappointing. This study sought to identify problems associated with and examine results of modular proximal femoral replacement. Outcomes were evaluated in two groups of patients: those receiving primary modular proximal femoral replacement for fractures and those treated with salvage arthroplasty for failed internal fixation.
Twelve patients who had received modular proximal femoral replacement as primary treatment for proximal femoral fractures were evaluated along with nine patients treated with salvage proximal femoral replacement for failed internal fixation. After the surgical procedure, patients were evaluated at regular follow-up intervals and contacted by phone at the conclusion of this study. Patient functional results were evaluated using the Merle D'Aubigne hip rating scale, which measures pain, motion and ambulatory status. Routine radiographs were also obtained at each patient visit.
On average, patients who received modular proximal femoral replacement as the primary surgery for their femoral fractures enjoyed a high-level functional result and had few complications. Subjects who received salvage femoral replacement had a less optimal outcome and experienced more complications. Nonetheless, final post-operative MDA score was significantly increased from pre-operative levels.
Modular proximal femoral replacement is a viable option in the primary fracture or revision setting, and has been shown to have a reasonable outcome, especially when the nature of initial injury is taken into account.
复杂股骨骨折的治疗面临重大挑战。即便有当前的技术进步以及用于股骨骨折固定的各种器械，治疗结果往往仍不尽人意。本研究旨在确定与模块化近端股骨置换相关的问题并检查其结果。对两组患者的结果进行了评估：一组是接受原发性模块化近端股骨置换治疗骨折的患者，另一组是接受挽救性关节成形术治疗内固定失败的患者。
对12例接受模块化近端股骨置换作为近端股骨骨折主要治疗方法的患者以及9例接受挽救性近端股骨置换治疗内固定失败的患者进行了评估。手术之后，定期对患者进行随访评估，并在本研究结束时通过电话联系患者。使用Merle D'Aubigne髋关节评分量表评估患者的功能结果，该量表用于衡量疼痛、活动度和行走状态。每次患者就诊时还获取常规X线片。
平均而言，接受模块化近端股骨置换作为股骨骨折主要手术的患者获得了高水平的功能结果且并发症较少。接受挽救性股骨置换的患者结果不太理想且并发症较多。尽管如此，术后最终的Merle D'Aubigne评分较术前水平有显著提高。
模块化近端股骨置换在原发性骨折或翻修手术中是一种可行的选择，并且已显示出具有合理的结果，尤其是在考虑初始损伤性质的情况下。
