Trilok Vilasagarapu, Kurupati Ranganatha Babu, Sherikar Nagesh, Basha K Moinuddin, Chakravarthy H Y Rakshith
Orthopaedics and Trauma, Sri Bhavani Hospital, Vijayawada, IND.
Orthopaedics and Trauma, MVJ Medical College and Research Hospital, Bangalore, IND.
Cureus. 2023 Sep 16;15(9):e45351. doi: 10.7759/cureus.45351. eCollection 2023 Sep.
Background In the case of elderly patients suffering from osteoporosis, the primary objectives of addressing comminuted intertrochanteric fractures are centered upon the recuperation of the patients' pre-fracture levels of activity, the expeditious promotion of full weight-bearing capacity, and the minimization of the likelihood of further surgical interventions. The adoption of hemiarthroplasty as a method for comminuted intertrochanteric fractures is proven as a means of hastening the recovery process, enabling early weight-bearing and mitigating the problems associated with extended bed rest. The outcomes that resulted from the application of this technique will be evaluated and analyzed as part of this study's objectives. Methodology A prospective study was conducted over the course of one year at a tertiary care hospital in the northern part of India. The study comprised a total of 30 individuals; however, unfortunately, one of the patients could not be located for further analysis. Patients of either gender in the age group of over 60 years old and with unstable osteoporotic intertrochanteric fractures were included (AO Foundation/Orthopaedic Trauma Association type 31-A2.2, A2.3, or 31-A3 group). Patients were observed at one, three, and six months after the surgical operation. The Harris Hip Score (HHS) was used for the functional outcome evaluation. Results Throughout the course of our analysis, we saw an increase in the overall HHS that was statistically significant. The HHS exhibited a mean value of 34.33 during the period of discharge, with a range of 32 to 39. It increased to 55.34 (range = 52-59) after one month of follow-up, and it continued to rise to 85.03 (range = 63-89) after three months of follow-up. It is important to note that the mean HHS reached 95.24 (range = 63-98) by the sixth month of follow-up. The study showed a statistically significant upward trend in HHS scores across all time periods (p < 0.001). Conclusions Early postoperative ambulation was made possible with the use of cemented prostheses, which contributed to patients' overall improvements in their functional results. Cemented primary bipolar hemiarthroplasty has emerged as a promising alternative for the treatment of unstable intertrochanteric fractures. The enhanced functional outcomes measured by the HHS provide evidence of this. The transtrochanteric technique has shown advantages in retaining the anatomical integrity of external rotators, minimizing the necessity for their resection, and reducing the danger of sciatic nerve injury. These advantages were displayed by the transtrochanteric approach. Moreover, owing to the implementation of wiring techniques, the larger trochanter could be conserved, resulting in enhanced postoperative recovery and expediting the return to the preoperative condition. When compared with other techniques of internal fixation, the utilization of cemented bipolar hemiarthroplasty demonstrated much-reduced rates of complications, such as the need for further surgery and implant failure.
背景 在老年骨质疏松患者中，处理股骨转子间粉碎性骨折的主要目标集中在恢复患者骨折前的活动水平、迅速促进完全负重能力以及将进一步手术干预的可能性降至最低。采用半髋关节置换术治疗股骨转子间粉碎性骨折已被证明是加速恢复过程、实现早期负重并减轻与长期卧床相关问题的一种方法。作为本研究目标的一部分，将对应用该技术所产生的结果进行评估和分析。
方法 在印度北部一家三级护理医院进行了为期一年的前瞻性研究。该研究共纳入30名个体；然而，不幸的是，其中一名患者无法找到进行进一步分析。纳入60岁以上、患有不稳定骨质疏松性股骨转子间骨折的男女患者（AO基金会/骨科创伤协会31 - A2.2、A2.3或31 - A3组）。在手术后1个月、3个月和6个月对患者进行观察。采用Harris髋关节评分（HHS）进行功能结局评估。
结果 在我们的分析过程中，我们发现总体HHS有统计学意义的增加。出院时HHS的平均值为34.33，范围为32至39。随访1个月后增加到55.34（范围 = 52 - 59），随访3个月后继续升至85.03（范围 = 63 - 89）。需要注意的是，到随访第6个月时，平均HHS达到95.24（范围 = 63 - 98）。该研究显示所有时间段的HHS评分均有统计学意义的上升趋势（p < 0.001）。
结论 使用骨水泥型假体使得术后早期活动成为可能，这有助于患者功能结果的整体改善。骨水泥型初次双极半髋关节置换术已成为治疗不稳定股骨转子间骨折的一种有前景的替代方法。HHS测量的功能结果增强证明了这一点。转子间技术在保持外旋肌的解剖完整性、尽量减少其切除的必要性以及降低坐骨神经损伤风险方面显示出优势。转子间入路体现了这些优势。此外，由于采用了钢丝固定技术，可以保留大转子，从而促进术后恢复并加快恢复到术前状态。与其他内固定技术相比，使用骨水泥型双极半髋关节置换术的并发症发生率大大降低，如再次手术的需要和植入物失败。
