Brunner Alexander, Büttler Markus, Lehmann Uwe, Frei Hans Curd, Kratter Renato, Di Lazzaro Marco, Scola Alexander, Sermon An, Attal Rene
Medical University Innsbruck, Department of Trauma Surgery, Anichstrasse 35, 6020 Innsbruck, Austria.
DePuy Synthes, Luzernstrasse 21, 4528 Zuchwil, Switzerland.
Injury. 2016 Feb;47(2):432-8. doi: 10.1016/j.injury.2015.11.027. Epub 2015 Dec 2.
To evaluate the outcome after different types of revision operations for blade 'cut-out' and 'cut-through' after fixation of trochanteric fractures with proximal femoral nail antirotation (PFNA) or a trochanter fixation nail (TFN).
Twenty hospitals participated in this multicentre study. A total of 4109 patients were retrospectively screened for cut-out or cut-through complications after nailing of trochanteric fractures using PFNA or TFN. Fifty-seven patients (28 with 'cut-through' and 29 with 'cut-out') were included in the study. In the 'cut-through' group, 16 patients underwent a blade exchange, six patients had a blade exchange with bone cement augmentation, and six received total hip arthroplasty (THA). In the 'cut-out' group, three patients had a blade exchange, one had a blade exchange with augmentation, three underwent re-nailing of the fracture with a new PFNA, one had a girdlestone procedure and 21 had THA procedures.
In the 'cut-through' group, eight patients who had a blade exchanges (50%) and two patients with blade exchange and augmentation (33%) required further revision operations. THA was the definite treatment in all 6 cases. In the 'cut-out' group, two patients (66%) who had blade exchanges and two (66%) who underwent re-nailing required additional revision operations during the subsequent course. One patient (4%) who had total hip arthroplasty needed revision surgery for acetabular replacement. Overall, a total of 81 revision procedures were performed.
Based on the data from this study, we recommend THA as the only valid salvage procedure for 'cut-out' and 'cut-through' of helical blades after fixation of trochanteric fractures with the PFNA and TFN.
评估使用股骨近端抗旋髓内钉（PFNA）或股骨转子间固定钉（TFN）固定转子间骨折后，针对刀片“穿出”和“穿透”进行不同类型翻修手术后的结果。
20家医院参与了这项多中心研究。对总共4109例使用PFNA或TFN治疗转子间骨折后出现穿出或穿透并发症的患者进行回顾性筛查。57例患者（28例“穿透”和29例“穿出”）纳入研究。在“穿透”组中，16例患者进行了刀片置换，6例患者进行了带骨水泥强化的刀片置换，6例接受了全髋关节置换术（THA）。在“穿出”组中，3例患者进行了刀片置换，1例进行了带强化的刀片置换，3例使用新的PFNA对骨折进行再次固定，1例进行了关节切除成形术，21例进行了THA手术。
在“穿透”组中，8例进行刀片置换的患者（50%）和2例进行刀片置换并强化的患者（33%）需要进一步的翻修手术。THA是所有6例患者的确定性治疗方法。在“穿出”组中，2例进行刀片置换的患者（66%）和2例进行再次固定的患者（66%）在后续过程中需要额外的翻修手术。1例接受全髋关节置换术的患者（4%）需要进行髋臼置换的翻修手术。总体而言，共进行了81次翻修手术。
基于本研究的数据，我们推荐THA作为使用PFNA和TFN固定转子间骨折后螺旋刀片“穿出”和“穿透”的唯一有效挽救手术。
