Zhou Jin-Hua, Wang Yu-Si, Sheng Bin, Li Xin, Guan Rui
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China.
Zhongguo Gu Shang. 2021 Mar 25;34(3):255-9. doi: 10.12200/j.issn.1003-0034.2021.03.013.
To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA).
From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation.
All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant (=29.7, <0.01). The VAS pain scores were (8.0±0.6) and (0.5±0.6) respectively before and 1 year after operation, and the difference was statistically significant(=80.7, <0.01). The intraoperative blood loss was (730±68) ml and (688±127) ml in patients with type B1 malnutrition risk and patients without malnutrition risk, and the difference was statistically significant (=4.6, <0.05);the intraoperative blood loss was (916±118) ml and (884±88) ml in patients with type B2 malnutrition risk and patients without malnutrition risk, and the difference was statistically significant (=8.7, <0.05). At the last follow-up, all the fractures were healed and the force line of lower limbs was good. No loosening, displacement, fracture of internal fixation, loosening and dislocation of prosthesis occurred during the follow-up period.
The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.
