股骨近端防旋髓内钉或动力髋螺钉固定稳定型（3.1A1）股骨转子间骨折失败后采用全髋关节置换手术治疗的疗效观察

Treatment with total hip arthroplasty for the failure of stable（3.1A1） femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw

目的 探讨近端防旋髓内钉（PENA）或动力髋螺钉（DHS）治疗固定稳定型（3.1A1.1-3）股骨转子间骨折股骨失败后经全髋关节置换手术（THA）处理的临床效果.方法 收集2007年1月至2016年4月克拉玛依市中心医院骨二科用DHS或PFNA固定稳定的股骨转子间骨折失败的192例（192髋）患者,对所有患者采用THA.对患者手术前后Harris髋关节评分（HSS评分）进行比较,观察并发症的发生情况.结果 每组患者术后HSS评分均较术前有明显提高,差异有统计学意义（P〈0.05）,两组间比较,差异无统计学意义（P〉0.05）.DHS组较PFNA组术后发生并发症较多,差异有统计学意义（P〈0.05）.结论 THA处理PENA或DHS失败的稳定型股骨转子间骨折的临床效果较好;术后并发症较易发生于首次手术采用DHS的患者,使用骨水泥型及非骨水泥型两种假体的差异无统计学意义（P〉0.05）.

Objective To investigate the clinical effect of total hip arthroplasty in the treatment of failure of femoral intertrochanteric fractures（3.1A1.1-3） with proximal femoral nail antirotaion or dynamic hip screw.Methods A retrospective study was performed on 192 patients（192 hips） underwent total hip arthroplasty（THA） to cure failed femoral intertrochanteric fractures surgery using proximal femoral nail antirotation or dynamic hip screw from January 2007 to April 2016.The preoperative and postoperative data,from the reasons for internal fixation failure,imaging changes,improved Harris score and postoperative complications were analyzed.Results The scores of Harris in each group were significantly higher than those before operation（P〈0.05）.There was no significant difference between the two groups.There were more postoperative complications in the DHS group compared with PFNA group,and the difference was statistically significant（P〈0.05）.Conclusion The total hip arthroplasty in the treatment of femoral intertrochanteric fractures with proximal femoral nail or dynamic hip screw failure has good clinical results.The postoperative complications are more likely to occur in patients with DHS for the first time,there is no significant difference between the two prostheses of bone cement and non-bone cement.