人工关节置换治疗老年股骨粗隆间骨折内固定失败

Hip arthroplasty for failed internal fixation of intertrochanteric fractures in the elderly

[目的]观察人工关节置换治疗老年股骨粗隆间骨折内固定失败的中期临床效果。[方法]回顾性分析本院2010年1月～2015年1月收治的21例因股骨粗隆间骨折复位内固定失败而行人工关节置换术的12例患者,男性12例,女性9例,平均年龄(68.56±3.21)岁(55～80岁)。16例行全髋关节置换术,5例行人工股骨头置换术。[结果]所有患者均手术顺利,术中均无不良事件发生,4例发生下肢周围型深静脉血栓,但无严重后果。2例随访期间因为癌症死亡,其余19例随访时间2～5年,平均(3.53±0.14)年。1例患者脱位后经闭合复位后恢复正常。其余无脱位病例发生。19例均无假体松动、感染和假体周围骨折发生。Harris评分由术前(38.56±7.25)分显著增加至末次随访时(89.58±6.72)分,差异有统计学意义(P<0.05)。[结论]人工关节置换作为股骨粗隆间骨折内固定失败后的有效补救措施,但由于内固定失败导致骨折缺损程度较重,较多患者需要重建股骨大小转子稳定性以及需要长柄假体进行固定,手术难度和创伤大,术中出血多。

[Objective] To explore the mid-term clinical outcome of hip arthroplasty for failed internal fixation of intertrochanteric fractures in the elderly. [Methods] A retrospective study was conducted on 21 patients who received hip arthroplasty for failed internal fixation of intertrochanteric fractures in our hospital from January of 2010 to January of 2015, including 12 males and 9 females aged from 55 to 80 years with an average of 69.5 years at the time of the fracture. Of them, 16 patients had total hip arthroplasty, whereas the remaining 5 patients had bipolar hip arthroplasty. [Results] All the 21 patients had surgery performed successfully without serious complications, despite the fact that peripheral DVT happened in 6 patients ＇after operation with no serious consequences. Except 2 patients who died of cancers during follow-up period, the remaining 19 patients were followed up from 2 to 5 years with an average of （3.53±0.14） years. Postoperative dislocation happened in 1 patient, which was successfully treated by close reduction without adverse consequence. No prosthetic loosening, infection and periprosthetic fracture occurred in anyone of the 19 patients. The Harris scores significantly improved from （38.56±7.25） preoperatively to （89.58±6.72） at the latest follow up, where was statistically significantly different （P〈0.05）. [Conclusion] Hip replacement is an effective salvage procedure for failed internal fixation of intertrochanteric fractures. However, the failed internal fixation usually leads bone loss that typically need reconstruction of both the greater and less trochanters or use of longer femoral stem with increased surgical difficulties and more blood loss