Department of Orthopedic Surgery, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea.
Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
Injury. 2019 Jul;50(7):1339-1346. doi: 10.1016/j.injury.2019.05.012. Epub 2019 May 20.
Despite the generally successful outcome of intertrochanteric fracture fixation, the treatment is challenging when fixation failure occurs. Some studies have reported a systemic treatment strategy for salvaging failed intertrochanteric fracture fixation. This prospective study with a retrospective review of data aimed to evaluate and validate the efficacy of an evidence-based protocol developed for the treatment of failed intertrochanteric fractures.
Between 1997 and 2016, 83 patients who could be followed up for more than 1 year after treatment were enrolled at an academic medical centre. An evidence-based protocol was established in July 2008 and was implemented prospectively. The treatment protocol was determined keeping in mind the condition of the femoral head, the deformation of the fracture site and the bone defect. Clinical results were evaluated, and fracture union and femoral neck-shaft angle were evaluated radiographically for patients in valgus osteotomy and re-fixation subgroups.
The Pain score, leg length discrepancy, Koval score for ambulatory levels and modified Harris Hip Score showed statistically significant improvement after the implementation of the new protocol. The radiographic success rate was 73% (27 of 37 patients) in the pre-protocol group and 91% (42 of 46 patients) in the post-protocol group, which shows statistically significantly improvement.
The new treatment strategy for failed intertrochanteric fracture fixation based on the condition of the femoral head, deformation of the fracture site and bone defect is successful based on clinical and radiographic results. Restoration of NSA of failed intertrochanteric fractures is a key factor for obtaining successful results.
尽管股骨转子间骨折固定的总体结果良好，但当固定失败时，治疗仍然具有挑战性。一些研究报告了一种针对固定失败的股骨转子间骨折的全身治疗策略。本前瞻性研究回顾性分析数据旨在评估和验证为治疗失败的股骨转子间骨折而制定的循证方案的疗效。
1997 年至 2016 年间，在一家学术医疗中心共纳入 83 例可随访治疗后超过 1 年的患者。2008 年 7 月建立了循证方案，并进行前瞻性实施。治疗方案是根据股骨头状况、骨折部位变形和骨缺损确定的。对行内翻截骨和再固定亚组的患者进行临床结果评估，并对骨折愈合和股骨颈干角进行影像学评估。
实施新方案后，疼痛评分、下肢长度差异、可步行 Koval 评分和改良 Harris 髋关节评分均有统计学显著改善。在预方案组，影像学成功率为 73%（37 例中的 27 例），在方案后组为 91%（46 例中的 42 例），差异有统计学意义。
基于股骨头状况、骨折部位变形和骨缺损的失败股骨转子间骨折固定的新治疗策略，基于临床和影像学结果是成功的。恢复失败的股骨转子间骨折的非甾体抗炎药是获得成功结果的关键因素。
