Chouhan Dushyant, Rai Alok, Nema Sandeep Kumar, Chouhan Shivam, Mishra Akash
Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Raipur, India.
Hip Pelvis. 2025 Jun 1;37(2):103-111. doi: 10.5371/hp.2025.37.2.103.
With the exception of revision osteosynthesis, conversion total hip arthroplasty (CTHA) following sliding hip screw (SHS) and cephalomedullary nail (CMN) failure in intertrochanteric fractures (ITF) is the most commonly used treatment option. This review determined the relative risk of medical and orthopedic complications, including periprosthetic femoral fractures (PFF), following CTHA in failed SHS and CMN fixation of ITF, as well as the Harris hip score (HHS). Major electronic databases were searched for studies and reports on CTHA after SHS and CMN fixation failures in ITF. To assess the risk of bias, the studies were analyzed using the Joanna Briggs Institute critical appraisal tool for cohort studies. Three studies pooled 327 cases and 353 cases of CTHA from failed CMN and SHS in ITF. The relative risk of medical and orthopedic complications and PFF in the SHS group as compared to the CMN group was 0.87 [0.39, 1.90], 1.64 [1.18, 2.29], and 1.92 [0.81, 4.56], respectively. The mean difference in HHS was -0.72 [-1.47, 0.02] between failed SHS and CMN groups. The included studies were of retrospective study design with a more than 20% loss of follow-up and a high risk of bias. There is 64% more risk of orthopedic complications with CTHA in SHS failures than CMN failures. There is no difference in relative risk of medical complications and PFF between CTHA in both SHS and CMN failure. After CTHA, the benefits in function are similar in both groups.
除翻修骨固定术外，在股骨转子间骨折（ITF）中，动力髋螺钉（SHS）和股骨近端髓内钉（CMN）固定失败后行全髋关节置换术（CTHA）是最常用的治疗选择。本综述确定了在ITF的SHS和CMN固定失败后行CTHA时发生包括假体周围股骨骨折（PFF）在内的医学和骨科并发症的相对风险，以及Harris髋关节评分（HHS）。检索了主要电子数据库中关于ITF的SHS和CMN固定失败后CTHA的研究和报告。为评估偏倚风险，使用乔安娜·布里格斯研究所队列研究批判性评价工具对研究进行分析。三项研究汇总了ITF中CMN和SHS固定失败后分别327例和353例CTHA病例。与CMN组相比，SHS组发生医学和骨科并发症及PFF的相对风险分别为0.87[0.39，1.90]、1.64[1.18，2.29]和1.92[0.81，4.56]。SHS和CMN固定失败组之间HHS的平均差异为-0.72[-1.47，0.02]。纳入的研究为回顾性研究设计，随访失访率超过20%，存在较高的偏倚风险。SHS固定失败后行CTHA发生骨科并发症的风险比CMN固定失败后高64%。SHS和CMN固定失败后行CTHA时医学并发症和PFF的相对风险无差异。CTHA后，两组在功能方面的获益相似。
