Institute for Joint Replacement, Department of Orthopedic Surgery, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan.
Department of Rehabilitation, Kyoto Katsura Hospital, Yamada-hirao-cho 17, Nishikyo-ku, Kyoto, 615-8256, Japan.
BMC Musculoskelet Disord. 2021 Feb 10;22(1):162. doi: 10.1186/s12891-021-04005-1.
In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter.
This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter.
Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group.
The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position.
We had approved IRB at our hospital clinical research review committee. Retrospectively registered.
在我们的研究所，所有移位的股骨颈骨折老年患者均采用改良 Dall 入路的骨水泥固定双极半髋关节置换术（BHA）治疗。据我们所知，目前尚无关于大转子再附着的结位置的报告。本研究的目的是确定两个结位置（前或后）对大转子并发症的影响。
这是一项前瞻性非随机研究，于 2013 年 9 月至 2017 年 12 月期间对 95 名老年患者（95 髋）进行。结位置从前向后交替改变。术后即刻获得的 X 射线图像与术后 3 个月获得的图像进行比较；此后，大转子的状态分为 3 型：A型，无明显移位和骨折；C 型，碎片移位超过 1mm；F 型，大转子骨折。
在手术时的年龄、性别、BMI、大转子碎片的大小、柄的类型和术者方面，两组之间没有显著差异。在前组中，34 髋（72.3%）、5 髋（10.6%）和 8 髋（17.0%）分别归类为 A、C 和 F 型。在后组中，44 髋（91.7%）、1 髋（2.1%）和 3 髋（6.3%）分别归类为 A、C 和 F 型。后组的大转子并发症明显较少。
与前结位置相比，BHA 后结位置可改善大转子的愈合。
我们已在我院临床研究审查委员会批准了 IRB。回顾性注册。
