University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
University of Florence, Orthopaedic Clinic CTO, Largo Palagi 1 50139 Florence, Italy.
Injury. 2021 Jul;52(7):1868-1874. doi: 10.1016/j.injury.2021.04.038. Epub 2021 Apr 16.
The use of proximal femoral replacements (PFR) has been recently described for catastrophic internal fixation failures. PFR is an attractive treatment option because it is technically straightforward and allows for immediate mobilization of the patient. The aim of the study was to determine the survivorship, functional outcome and complications' rate in a group of elderly patients who underwent proximal femoral replacement as a salvage treatment after femur cephalomedullary nails' mechanical failures.
We evaluated 21 patients who underwent salvage of a failed cephalomedullary nail by using a single design PFR at our institution between 2014-2017. A cemented stem was used in all cases. Radiographs were assessed for fractures, sign of loosening, presence of heterotopic ossification and leg length discrepancy. Functional evaluation was performed through Harris Hip Score (HHS), FIM™ and Time Up and Go test (TUG). Kaplan-Meier estimator was used to determine the overall implants' survival.
The average age at the time of surgery was 83years. The mean follow-up was 3.1years. We recorded 3 dislocations of which 2 required a revision. No case of septic or aseptic failure was reported. Two patients died respectively at 11 and 14 months after surgery. At the last follow-up the mean HHS, FIM™, and the TUG improved significantly (p<0.05).
Immediate weight bearing, good functional outcomes, low complications' and one-year mortality rate make the proximal femur replacement with megaprostheses a potential first line treatment of intertrochanteric/subtrochanteric fixations' failures among elderly, osteoporotic, frail patients. Dislocation is the most common complication to bear in mind within the first six months after surgery.
最近有研究报道使用股骨近端假体置换（PFR）治疗灾难性内固定失败。PFR 是一种有吸引力的治疗选择，因为它技术上简单直接，并允许患者立即活动。本研究旨在确定一组老年患者在股骨顺行髓内钉机械失败后接受股骨近端置换作为挽救性治疗的生存率、功能结果和并发症发生率。
我们评估了 2014 年至 2017 年间在我们机构因股骨顺行髓内钉失败而接受单型 PFR 挽救治疗的 21 例患者。所有病例均使用骨水泥型假体。通过 X 线评估骨折、松动迹象、异位骨化和肢体长度差异。通过髋关节 Harris 评分（HHS）、功能独立性评定量表（FIM）和计时起立行走测试（TUG）评估功能。使用 Kaplan-Meier 估计器确定总体植入物的存活率。
手术时的平均年龄为 83 岁。平均随访时间为 3.1 年。我们记录了 3 例脱位，其中 2 例需要翻修。未报告感染或无菌性失败的病例。2 例患者分别在术后 11 个月和 14 个月死亡。末次随访时，HHS、FIM 和 TUG 均显著改善（p<0.05）。
立即负重、良好的功能结果、低并发症发生率和一年死亡率使 megaprostheses 股骨近端置换成为老年、骨质疏松、虚弱患者股骨转子间/转子下固定失败的潜在一线治疗方法。术后 6 个月内最常见的并发症是脱位。
