股骨转子间骨折使用股骨近端髓内钉内固定术后失败的翻修策略
|
摘要
目的探讨股骨近端髓内钉治疗股骨转子间骨折术后内固定失败的翻修策略。方法选取2010年1月至2018年6月因股骨转子间骨折行股骨近端髓内钉内固定治疗后内固定失败的患者23例,采用关节置换或更换内固定+断端植骨进行治疗。评估手术前后Harris评分及SF-12生存质量评分。结果所有病例均顺利完成手术并出院。平均随访时间22.3个月。末次Harris评分[(86.6±5.7)分]相比术前[(34.2±15.1)分]差异有统计学意义(P <0.01);末次SF-12评分[生理总得分(48.6±2.1)分,心理总得分(46.5±2.9)分]相比术前[生理总得分(26.5±2.8)分,心理总得分(28.7±2.7)分]差异有统计学意义(P <0.01)。随访期间2例患者死亡,所有病例无假体松动及内固定移位并发症。结论股骨近端髓内钉治疗股骨转子间骨折术后内固定失败的翻修应根据具体情况来选择不同治疗方案,患者年龄、身体状况、骨折类型、内固定失败类型均为考虑因素。
Objective Evaluation of the revision for failed proximal femur intramedullary nail of intertro-chanteric fracture. Methods A retrospective analysis was carried out in 23 intertrochanteric fracture patients of failed proximal femur intramedullary nail in our department from January 2010 to June 2018. Arthroplasty or replace internal fixation + bone graft were treated for revision. Harris hip score and SF-12 score were evaluated before and aftersurgery. Results All cases finished surgery successfully and the patients had already discharged.The follow-up time was 22.3 months in average. The mean value of the last Harris hip score(86.6 ± 5.7),mean value of the last SF-12 score[physical component summary(48.6 ± 2.1),mental component summary(46.5 ±2.9)]were significant higher than pre-operation[Harris hip score(34.2 ± 15.1),P < 0.01;physical component summary(26.5 ± 2.8),mental component summary(28.7 ± 2.7),P < 0.001]. 2 cases died during follow-up. All cases didn′t show prosthesis loosening and internal fixation migration. Conclusions The treatment of failed proxi-mal femur intramedullary nail depend on specific condition. The age,physical conditions,type of fracture and type of failed should be taken into considerations.
Objective Evaluation of the revision for failed proximal femur intramedullary nail of intertro-chanteric fracture. Methods A retrospective analysis was carried out in 23 intertrochanteric fracture patients of failed proximal femur intramedullary nail in our department from January 2010 to June 2018. Arthroplasty or replace internal fixation + bone graft were treated for revision. Harris hip score and SF-12 score were evaluated before and aftersurgery. Results All cases finished surgery successfully and the patients had already discharged.The follow-up time was 22.3 months in average. The mean value of the last Harris hip score(86.6 ± 5.7),mean value of the last SF-12 score[physical component summary(48.6 ± 2.1),mental component summary(46.5 ±2.9)]were significant higher than pre-operation[Harris hip score(34.2 ± 15.1),P < 0.01;physical component summary(26.5 ± 2.8),mental component summary(28.7 ± 2.7),P < 0.001]. 2 cases died during follow-up. All cases didn′t show prosthesis loosening and internal fixation migration. Conclusions The treatment of failed proxi-mal femur intramedullary nail depend on specific condition. The age,physical conditions,type of fracture and type of failed should be taken into considerations.
引文
[1]翁蔚宗,李密,周启荣,等.髋部骨折流行病学分布特点:单中心2859例分析[J].第二军医大学学报,2017,38(4):415-420.
[2]PRIOR J C,LANGSETMO L,LENTLE B C,et al.Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study-Comparing site and agespecific risks in women and men[J].Bone,2015,71(2):237-243.
[3]刘昊楠,贺良,张贵林,等.髋部骨折住院患者治疗情况的初步分析[J].实用医学杂志,2015,31(24):4087-4089.
[4]吴新宝.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.
[5]VAN E D,STOLLENWERCK G A,KOSTER L A,et al.The stability of fixation of proximal femoral fractures:A radiostereometric analsis[J].Bone Joint J,2015,97-B(3):391.
[6]VERETTAS D A,IFANTIDIS P,CHATZIPAPAS C N,et al.Systematic effects of surgical treatment of hip fractures:Gliding screw-plating vs intramedullary nailing[J].Injury,2010,41(3):279-284.
[7]HUANG S G,CHEN B,ZHANG Y,et al.Comparison of the clinical effectiveness of PFNA,PFLCP,and DHS in treatment of unstable intertrochanteric femoral fracture[J].Am J Ther,2015,24(6):659-666.
[8]陈新宇.PFNA与DHS治疗超高龄股骨粗隆间骨折的疗效分析[J].实用医学杂志,2015,31(12):1993-1995.
[9]富仁杰,徐晓峰,曹兴兵,等.股骨粗隆间骨折PFNA内固定失效的危险因素分析[J].中国骨与关节损伤杂志,2015,30(6):582-585.
[10]NIE B,CHEN X,JING L,et al.The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall:A biomechanical study[J].J Orthop Surg Res,2017,12(1):197.
[11]KUIPER B W,GRAYBILL S,TATE J,et al.After the fall:Improving osteoporosis treatment following hip fracture[J].Osteoporos Int,2018,29(6):1295-1301.
[12]VERONESE N,MAGGI S.Epidemiology and social costs of hip frature[J].Injury,2018,49(8):1458-1460.
[13]CRAM P,YAN L,BOHM E,et al.Trends in operative and nonoperative hip fracture management 1990-2014:A longitudinal analysis of manitoba administrative data[J].J Am Geriatr Soc,2017,65(1):27-34.
[14]MUSTAFA C,EMRE T,OZKAN K.Calcar preservation arthroplasty for unstable intertrochanteric femoral fractures in elderly[J].Clin Orthop Surg,2015,7(4):436-442.
[15]BRUNNER A,BüTTLER M,LEHMANN U,et al.What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?:A multicentre study[J].Injury,2016,47(2):432-438.
[16]SHI X,ZHOU Z,YANG J,et al.Total hip arthroplasty using non-modular cementless long-stem distal fixation for salvage of failed internal fixation of intertrochanteric fracture[J].J Arthroplasty,2015,30(11):1999-2003.
[17]王广辉,许杰,郭坤营,等.髋部骨折内固定失败后的全髋关节置换术疗效评估及影响因素分析[J].中华关节外科杂志(电子版),2012,6(2):44-47.
[2]PRIOR J C,LANGSETMO L,LENTLE B C,et al.Ten-year incident osteoporosis-related fractures in the population-based Canadian Multicentre Osteoporosis Study-Comparing site and agespecific risks in women and men[J].Bone,2015,71(2):237-243.
[3]刘昊楠,贺良,张贵林,等.髋部骨折住院患者治疗情况的初步分析[J].实用医学杂志,2015,31(24):4087-4089.
[4]吴新宝.老年髋部骨折诊疗专家共识(2017)[J].中华创伤骨科杂志,2017,19(11):921-927.
[5]VAN E D,STOLLENWERCK G A,KOSTER L A,et al.The stability of fixation of proximal femoral fractures:A radiostereometric analsis[J].Bone Joint J,2015,97-B(3):391.
[6]VERETTAS D A,IFANTIDIS P,CHATZIPAPAS C N,et al.Systematic effects of surgical treatment of hip fractures:Gliding screw-plating vs intramedullary nailing[J].Injury,2010,41(3):279-284.
[7]HUANG S G,CHEN B,ZHANG Y,et al.Comparison of the clinical effectiveness of PFNA,PFLCP,and DHS in treatment of unstable intertrochanteric femoral fracture[J].Am J Ther,2015,24(6):659-666.
[8]陈新宇.PFNA与DHS治疗超高龄股骨粗隆间骨折的疗效分析[J].实用医学杂志,2015,31(12):1993-1995.
[9]富仁杰,徐晓峰,曹兴兵,等.股骨粗隆间骨折PFNA内固定失效的危险因素分析[J].中国骨与关节损伤杂志,2015,30(6):582-585.
[10]NIE B,CHEN X,JING L,et al.The medial femoral wall can play a more important role in unstable intertrochanteric fractures compared with lateral femoral wall:A biomechanical study[J].J Orthop Surg Res,2017,12(1):197.
[11]KUIPER B W,GRAYBILL S,TATE J,et al.After the fall:Improving osteoporosis treatment following hip fracture[J].Osteoporos Int,2018,29(6):1295-1301.
[12]VERONESE N,MAGGI S.Epidemiology and social costs of hip frature[J].Injury,2018,49(8):1458-1460.
[13]CRAM P,YAN L,BOHM E,et al.Trends in operative and nonoperative hip fracture management 1990-2014:A longitudinal analysis of manitoba administrative data[J].J Am Geriatr Soc,2017,65(1):27-34.
[14]MUSTAFA C,EMRE T,OZKAN K.Calcar preservation arthroplasty for unstable intertrochanteric femoral fractures in elderly[J].Clin Orthop Surg,2015,7(4):436-442.
[15]BRUNNER A,BüTTLER M,LEHMANN U,et al.What is the optimal salvage procedure for cut-out after surgical fixation of trochanteric fractures with the PFNA or TFN?:A multicentre study[J].Injury,2016,47(2):432-438.
[16]SHI X,ZHOU Z,YANG J,et al.Total hip arthroplasty using non-modular cementless long-stem distal fixation for salvage of failed internal fixation of intertrochanteric fracture[J].J Arthroplasty,2015,30(11):1999-2003.
[17]王广辉,许杰,郭坤营,等.髋部骨折内固定失败后的全髋关节置换术疗效评估及影响因素分析[J].中华关节外科杂志(电子版),2012,6(2):44-47.