Lee Young-Kyun, Kim Jung Taek, Alkitaini Awad Abdalla, Kim Ki-Choul, Ha Yong-Chan, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
Department of Orthopaedic Surgery, Sharg Alneel Hospital, Khartoum, Sudan.
J Arthroplasty. 2017 May;32(5):1593-1598. doi: 10.1016/j.arth.2016.12.018. Epub 2016 Dec 22.
Conversion hip arthroplasty is a salvage procedure for failed internal fixation of intertrochanteric fractures. However, the technical difficulties and perioperative morbidity of conversion arthroplasty are uncertain.
We compared the type of arthroplasty (total hip arthroplasty or hemiarthroplasty), operative parameters, perioperative morbidity, 1-year mortality, implant stability, and clinical results of 33 conversion hip arthroplasties due to a failed internal fixation of intertrochanteric fracture with those of a matched control group of 33 primary hip arthroplasties due to the same fracture. Propensity score was used for the control matching of gender, age, and body mass index.
Total hip arthroplasty was more frequently performed in the conversion group (10/33) compared to the primary group (3/33) (P = .016). The operation time, perioperative blood loss, amount of transfusion, and risk of femoral fracture during the operation were increased in the conversion group. The overall 1-year mortality was 3% (1 patient) in the conversion group and 9% (3 patients) in the primary group (P = .307). At a mean of 3-year follow-up, there was no significant difference in clinical results and none of the implants were loose in both groups.
In patients with failed internal fixation of intertrochanteric fracture, conversion hip arthroplasty should be planned and executed, bearing in mind the increased operative morbidities corresponding to operation time, perioperative blood loss, requirement of transfusion, and intraoperative femoral fracture.
髋关节翻修置换术是一种用于股骨转子间骨折内固定失败的挽救性手术。然而，翻修置换术的技术难度和围手术期发病率尚不确定。
我们将33例因股骨转子间骨折内固定失败而行髋关节翻修置换术患者的置换类型（全髋关节置换术或半髋关节置换术）、手术参数、围手术期发病率、1年死亡率、植入物稳定性和临床结果，与33例因相同骨折而行初次髋关节置换术的匹配对照组进行了比较。采用倾向评分法对性别、年龄和体重指数进行对照匹配。
与初次置换组（3/33）相比，翻修置换组（10/33）更常进行全髋关节置换术（P = .016）。翻修置换组的手术时间、围手术期失血量、输血量和手术期间股骨骨折风险均增加。翻修置换组的总体1年死亡率为3%（1例患者），初次置换组为9%（3例患者）（P = .307）。平均随访3年时，两组的临床结果无显著差异，且两组均无植入物松动。
对于股骨转子间骨折内固定失败的患者，在计划和实施髋关节翻修置换术时，应考虑到与手术时间、围手术期失血量、输血需求和术中股骨骨折相应增加的手术发病率。
