股骨近端骨折治疗失败后的全髋关节置换术。

Total hip arthroplasty after failed treatment of proximal femur fracture.

作者信息

Tetsunaga Tomonori, Fujiwara Kazuo, Endo Hirosuke, Noda Tomoyuki, Tetsunaga Tomoko, Sato Toru, Shiota Naofumi, Ozaki Toshifumi

机构信息

Department of Orthopaedic Surgery, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.

Department of Orthopaedic Surgery, Okayama Medical Center, 1711-1 Tamasu, Kitaku, Okayama, 701-1192, Japan.

出版信息

Arch Orthop Trauma Surg. 2017 Mar;137(3):417-424. doi: 10.1007/s00402-017-2631-0. Epub 2017 Jan 23.

DOI:10.1007/s00402-017-2631-0

PMID:28116505

Abstract

INTRODUCTION

Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures.

MATERIALS AND METHODS

We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment.

RESULTS

Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p < 0.0001). Postoperative complications in the trochanteric fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p < 0.0001 for both).

CONCLUSIONS

Performing THA after failed treatment of trochanteric fractures requires consideration of complication risk and incorrect femoral neck anteversion.

摘要

引言

全髋关节置换术（THA）作为股骨近端骨折治疗失败后的挽救手术是一个不错的选择。然而，股骨近端的解剖结构使得该手术复杂且具有挑战性。本研究的目的是评估股骨近端骨折治疗失败后行THA的影像学和临床结果。

材料与方法

我们回顾性分析了50例连续的股骨近端骨折治疗失败后行THA的病例（42例女性，8例男性；平均年龄77岁）。术后平均随访58.1个月。术前诊断为18髋股骨颈骨折，32髋转子间骨折，其中3例为感染性骨折。失败原因包括22例假体松动、12例骨坏死、9例内固定失败致骨不连、4例术后骨关节炎以及3例感染。比较的因素包括影像学评估、并发症发生率、视觉模拟评分（VAS）和Harris髋关节评分（HHS）。影像学变量包括股骨颈前倾角以及髋臼杯和股骨柄的对线情况。

结果

股骨颈骨折组患侧与健侧股骨颈前倾角差值的绝对值为6.0°，转子间骨折组为19.2°（p = 0.01）。髋臼杯前倾角（p = 0.20）或股骨柄前倾角（p = 0.08）无显著差异。转子间骨折组的并发症发生率显著高于股骨颈骨折组（25%对0%，p < 0.0001）。转子间骨折组的术后并发症包括3例假体周围骨折（9.4%）、2例脱位（6.3%）、2例手术部位感染（6.3%）和1例股骨柄穿出（3.1%）。尽管末次随访时两组在VAS或HHS方面无显著差异（分别为p = 0.32、0.09），但两组在末次随访时这些指标均有显著改善（两者p均< 0.0001）。