大粗隆爪钢板结合全髋关节置换术治疗陈旧性股骨粗隆间骨折12例中期随访报告

Use of cable plate in the total hip arthroplasty for the failed treatment of dated intertrochanteric fracture of the femur: mid-term follow-up results of 12 cases

目的报告大粗隆爪钢板结合全髋关节置换术（total hip arthroplasty,THA）治疗陈旧性股骨粗隆间骨折的中期随访结果。方法回顾性分析2005年至2012年,治疗失败的12例（12髋）股骨粗隆间骨折患者人工全髋关节置换术结合爪钢板重建大粗隆骨不连的临床疗效。10例（10髋）随访24-81个月,平均42.7个月。关节置换术时的患者平均年龄为62.3（41-80）岁。临床疗效以Harris评分、X线片进行评价。结果末次随访时髋关节Harris评分平均87.3（75-94）分,与术前平均17.4（6-38）分比较,差异有统计学意义（P〈0.001）。末次随访时3例存在大粗隆部位疼痛,4例残留患肢跛行。9例大粗隆骨不连均获得骨性愈合,1例为纤维愈合。未见钢板移位和钢缆断裂。并发症包括脱位1例和医源性坐骨神经损伤1例。12例均无需翻修。结论对于股骨粗隆间骨折初期治疗失败病例采用THA结合爪钢板重建大粗隆骨不连中期临床疗效较为满意。

Objective To evaluate medium-term clinical and radiographic results of the cable plate in the total hip arthroplasty for the failed treatment of intertrochanteric fracture of the femur. Methods From 2005 to 2012, 12 patients（ 12 hips） with failed treatment of the intertrochanteric fracture of the femur were treated with total hip arthroplasty plus the reconstruction of the greater trochanter with the cable plate. Ten patients（ 10 hips） were followed up for more than 2 years. The average duration of the follow-up was 42.7 months（ range： 24- 81 months）. The average age at the arthroplasty was 62.3 years（ range： 41- 80 years）. Clinical results were evaluated by Harris hip score, while radiographic results were analyzed by postoperative serial X-ray films. Results The average Harris hip score increased from preoperative 17.4 points（ range： 6- 38 points） to 87.3 points（ range： 75- 94 points） at the latest follow-up with statistical significance（ P 〈0.001）. Pain in the greater trochanter was seen in 3 hips, and limp in 4 hips at the latest follow-up. Bony union was observed in 9 hips and fibrous union was observed in 1 hip. No signs of plate dislocation or cable breakage were seen. Postoperative complications included 1 iatrogenic sciatic nerve injury and 1 dislocation. Revision was not needed in 12 cases. Conclusions Clinical and radiographic results of cable plate reconstruction for the greater trochanter in the total hip arthroplasty for the failed treatment of intertrochanteric fracture of the femur are satisfactory. Although it is technically demanding, the rate of bone union is excellent. Meanwhile, we should emphasize the necessity of postoperative muscle exercises for the improvement of gait.