BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechani...BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.展开更多
目的:探究老年股骨转子间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术后颈干角丢失的影响因素。方法:选取2019年8月至2021年10月采用PFNA内固定术治疗的单侧闭合性股骨转子间骨折患者为研究对象,从...目的:探究老年股骨转子间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术后颈干角丢失的影响因素。方法:选取2019年8月至2021年10月采用PFNA内固定术治疗的单侧闭合性股骨转子间骨折患者为研究对象,从病历系统中提取数据,包括年龄、性别、体质量指数、基础疾病、Evans分型、骨折原因、受伤至手术时间、术前长期卧床情况、骨质疏松程度、术前抗骨质疏松治疗情况、Singh指数、股骨近端外侧壁厚度、手术至下地负重时间。术后1年颈干角与术中纠正后颈干角差值≥10°即判定为颈干角丢失,按颈干角是否丢失将患者分为丢失组和未丢失组。先对2组患者的相关信息进行比较,然后将组间差异有统计学意义的因素作为自变量,将术后颈干角丢失情况作为因变量,进行Logistic多因素回归分析。结果:共纳入118例患者,丢失组21例、未丢失组97例。2组患者合并糖尿病情况、术前长期卧床情况、Singh指数、骨质疏松程度、术前抗骨质疏松治疗情况、股骨近端外侧壁厚度的组间差异均有统计学意义,其余各因素的组间差异均无统计学意义。Logistic多因素回归分析结果显示,合并骨质疏松症、Singh指数1~3级、术前未抗骨质疏松治疗均为老年股骨转子间骨折患者PFNA内固定术后颈干角丢失的危险因素[B=0.349,P=0.007,OR=1.148,95%CI(1.313,1.571);B=0.515,P=0.001,OR=1.673,95%CI(1.463,1.814);B=0.218,P=0.015,OR=1.243,95%CI(1.052,1.529)],股骨近端外侧壁厚度为保护因素[B=-0.214,P=0.002,OR=0.807,95%CI(0.736,0.964)]。结论:合并骨质疏松症、Singh指数1~3级、术前未抗骨质疏松治疗、股骨近端外侧壁厚度偏小均可导致老年股骨转子间骨折患者PFNA内固定术后颈干角丢失风险增加。展开更多
目的应用Meta分析系统比较近十年来人工髋关节置换术(hip arthroplasty,HA)与股骨近端防旋髓内钉内固定术(proximal femoral nail antirotation,PFNA)在治疗骨质疏松性不稳定型股骨转子间骨折的治疗效果。方法通过计算机检索中国知网、...目的应用Meta分析系统比较近十年来人工髋关节置换术(hip arthroplasty,HA)与股骨近端防旋髓内钉内固定术(proximal femoral nail antirotation,PFNA)在治疗骨质疏松性不稳定型股骨转子间骨折的治疗效果。方法通过计算机检索中国知网、万方、维普、CBM、PubMed、Embase、Web of Science、Cochrane图书馆及Embase数据库中关于PFNA与HA两种术式在治疗骨质疏松性不稳定型股骨转子间骨折的随机对照研究,检索时限为2011年1月至2021年12月,由2位研究员独立筛选文献,提取资料并评价纳入研究的偏倚风险后,将符合纳入标准的文献导入RevMan 5.4.0软件进行Meta分析。结果纳入14项相关实验研究,共包含1553例患者;PFNA术式组与HA术式组相比更占优势,其手术时长更短[MD=-19.48,95%CI(-24.46,-14.51),P<0.001]、术中出血量[MD=-101.90,95%CI(-135.58,-68.22),P<0.001]及术后引流量[MD=-9.94,95%CI(-11.97,-7.91),P<0.001]更少,但术后站立时间晚[MD=8.46,95%CI(4.22,12.71),P<0.001];术后总并发症及术后Harris评分两手术组无统计学意义差异(P>0.05)。结论与HA术相比,PFNA可以降低术中的操作时间、术中出血量以及术后引流量;HA较PFNA能够早期进行下床功能锻炼;但二者在术后总并发症及髋关节功能恢复上无显著差异。展开更多
文摘BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.
文摘目的:探究老年股骨转子间骨折患者股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术后颈干角丢失的影响因素。方法:选取2019年8月至2021年10月采用PFNA内固定术治疗的单侧闭合性股骨转子间骨折患者为研究对象,从病历系统中提取数据,包括年龄、性别、体质量指数、基础疾病、Evans分型、骨折原因、受伤至手术时间、术前长期卧床情况、骨质疏松程度、术前抗骨质疏松治疗情况、Singh指数、股骨近端外侧壁厚度、手术至下地负重时间。术后1年颈干角与术中纠正后颈干角差值≥10°即判定为颈干角丢失,按颈干角是否丢失将患者分为丢失组和未丢失组。先对2组患者的相关信息进行比较,然后将组间差异有统计学意义的因素作为自变量,将术后颈干角丢失情况作为因变量,进行Logistic多因素回归分析。结果:共纳入118例患者,丢失组21例、未丢失组97例。2组患者合并糖尿病情况、术前长期卧床情况、Singh指数、骨质疏松程度、术前抗骨质疏松治疗情况、股骨近端外侧壁厚度的组间差异均有统计学意义,其余各因素的组间差异均无统计学意义。Logistic多因素回归分析结果显示,合并骨质疏松症、Singh指数1~3级、术前未抗骨质疏松治疗均为老年股骨转子间骨折患者PFNA内固定术后颈干角丢失的危险因素[B=0.349,P=0.007,OR=1.148,95%CI(1.313,1.571);B=0.515,P=0.001,OR=1.673,95%CI(1.463,1.814);B=0.218,P=0.015,OR=1.243,95%CI(1.052,1.529)],股骨近端外侧壁厚度为保护因素[B=-0.214,P=0.002,OR=0.807,95%CI(0.736,0.964)]。结论:合并骨质疏松症、Singh指数1~3级、术前未抗骨质疏松治疗、股骨近端外侧壁厚度偏小均可导致老年股骨转子间骨折患者PFNA内固定术后颈干角丢失风险增加。
文摘目的应用Meta分析系统比较近十年来人工髋关节置换术(hip arthroplasty,HA)与股骨近端防旋髓内钉内固定术(proximal femoral nail antirotation,PFNA)在治疗骨质疏松性不稳定型股骨转子间骨折的治疗效果。方法通过计算机检索中国知网、万方、维普、CBM、PubMed、Embase、Web of Science、Cochrane图书馆及Embase数据库中关于PFNA与HA两种术式在治疗骨质疏松性不稳定型股骨转子间骨折的随机对照研究,检索时限为2011年1月至2021年12月,由2位研究员独立筛选文献,提取资料并评价纳入研究的偏倚风险后,将符合纳入标准的文献导入RevMan 5.4.0软件进行Meta分析。结果纳入14项相关实验研究,共包含1553例患者;PFNA术式组与HA术式组相比更占优势,其手术时长更短[MD=-19.48,95%CI(-24.46,-14.51),P<0.001]、术中出血量[MD=-101.90,95%CI(-135.58,-68.22),P<0.001]及术后引流量[MD=-9.94,95%CI(-11.97,-7.91),P<0.001]更少,但术后站立时间晚[MD=8.46,95%CI(4.22,12.71),P<0.001];术后总并发症及术后Harris评分两手术组无统计学意义差异(P>0.05)。结论与HA术相比,PFNA可以降低术中的操作时间、术中出血量以及术后引流量;HA较PFNA能够早期进行下床功能锻炼;但二者在术后总并发症及髋关节功能恢复上无显著差异。
基金the Supportive Program of Hunan Provincial Science and Technology Bureau,No.2012TP4021-4the grant from the Science and Technology Department of Chenzhou City,No.2012CT116~~
