股骨粗隆间骨折髓内固定失败后人工髋关节置换△

Total hip arthroplasty for failed intramedullary fixation of intertrochanteric fractures

摘要:

［目的］ 探讨人工髋关节置换治疗股骨粗隆间骨折髓内固定失败的临床效果。［方法］ 回顾性分析 2014 年６月— 2019 年 12 月在本科行人工髋关节置换治疗股骨粗隆间骨折 PFNA 内固定失败 21 例 （21 髋） 患者的临床资料，记录围手术期及随访结果。［结果］所有患者均顺利完成手术，术中无血管、神经损伤等并发症，手术时间平均（153.53±12.45） min；术中失血量平均 （400.52±45.97） ml；输血量平均 （250.65±66.82） ml。术后切口愈合良好。所有患者均获随访，随访时间平均 （20.70±6.90）个月，术后随时间推移，Harris 髋关节功能评分、SF-12 生活质量评分显著增加（P<0.05）。随访期间无假体周围感染、骨折、术后脱位等严重并发症；影像学评估无假体松动、骨溶解、异位骨化等严重并发症。［结论］ 对股骨粗隆间骨折 PFNA 内固定失败患者，人工髋关节置换是挽救关节功能，提高生活质量的有效治疗方式。

Abstract:

[Objective] To evaluate the clinical outcomes of total hip arthroplasty (THA) in the treatment of failed intramedullary fixa- tion for femoral intertrochanteric fractures. [Methods] A retrospective study was conducted on 21 patients (21 hips) who underwent THA in our department for failed proximal femoral nail anti-rotation (PFNA) fixation of femoral intertrochanteric fractures from June 2014 to De- cember 2019. The perioperative and follow-up documents were summarized. [Results] All the patients were operated on smoothly without serious complications, such as vascular and nerve damage during the operation, whereas with operation time of (153.53±12.45) min, intraop- erative blood loss of (400.52±45.97) ml, blood transfusion of (250.65±66.82) ml, and well incision healing. As time went during the followup period lasted for (20.70±6.90) months on average, both the Harris and SF-12 scores increased significantly (P＜0.05) . No serious late complications, such as periprosthetic fracture, periprosthetic joint infection, as well as aseptic loosening, periprosthetic osteolysis and het- erotopic ossification seen on images were noticed in anyone of them to the latest follow up. [Conclusion] THA is effective treatment to save joint function and improve the quality of life for failed PFNA fixation of intertrochanteric fractures.