School of Medicine, Henan University, Kaifeng, 475004, Henan, People's Republic of China.
Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Zhengzhou, 45000, Henan, People's Republic of China.
Eur J Med Res. 2019 Dec 27;24(1):39. doi: 10.1186/s40001-019-0398-1.
Intertrochanteric fracture is a common fracture suffered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues.
18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fixation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fixation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fixed using wire or steel when necessary. Patients' Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation.
15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased significantly, from 32.68 ± 12.04 points before surgery to 91.08 ± 5.9 points at 24 months post-treatment. SF-36 scores were significantly increased.
THA as salvage treatment for failed internal fixation of intertrochanteric femoral fractures in elderly patients significantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory.
股骨转子间骨折是老年患者常见的骨折。全髋关节置换术（THA）被认为是一种挽救髋关节功能的手术，用于治疗固定失败后的股骨转子间骨折，但由于一些临床潜在问题，该手术仍存在一定争议。
回顾性分析 2013 年 9 月至 2016 年 10 月收治的 18 例老年股骨转子间骨折内固定失败患者，均行 THA 治疗。内固定治疗涉及 5 例股骨近端防旋髓内钉（PFNA），7 例锁定近端股骨接骨板，6 例动力髋螺钉（DHS）。所有患者均采用生物髋臼假体和髋关节置换（HA）涂层股骨假体进行 THA，必要时使用钢丝或钢线固定大转子。采用 Harris 评分、SF-36 健康问卷评分和数字放射学（DR）评估关节假体初始稳定性和生存率。
15 例患者完成了 19 至 54 个月的随访（平均 26.2 个月；1 例患者死于肺栓塞，1 例患者术后 1 年死于肺心病，1 例患者因个人原因退出）。无关节感染、假体周围骨折或脱位。平均 Harris 评分由术前的 32.68±12.04 分显著提高至术后 24 个月的 91.08±5.9 分。SF-36 评分显著升高。
THA 作为老年股骨转子间骨折内固定失败的挽救性治疗方法，可显著减轻髋关节疼痛，恢复关节功能，早期临床效果满意。
