生物型全髋置换治疗股骨转子间骨折髓内钉固定术后创伤性关节炎的中期疗效

目的:分析生物型全髋关节置换(total hip arthroplasty,THA)治疗股骨转子间骨折髓内钉固定术后创伤性关节的中期疗效。方法:回顾性分析2012年1月至2017年1月治疗的22例转子间骨折髓内钉固定术后继发创伤性关节炎患者,其中男10例,女12例;年龄61~84(72.5±9.8)岁。初次内固定方式:Gamma钉固定14例,PFNA固定8例。内固定术后至THA时间10~68(32.2±21.3)个月。比较术前及术后髋关节Harris评分,通过术后3、6、12个月及末次随访影像学评估假体位置。结果:1例在术后1年死于心衰,2例术后2年死于晚期肿瘤,其余19例患者获得随访,时间36~64(48.5±11.9)个月。末次随访时14例可自由行走,4例需单手杖辅助,1例需助步器辅助。随访期间无关节脱位、假体周围骨折及深静脉血栓形成等严重并发症发生。髋关节Harris评分由术前的(29.2±12.9)分提高到末次随访的(74.2±11.2)分(P<0.05);其中优9例,良7例,可3例。结论:生物型全髋关节置换术治疗股骨转子间骨折髓内钉固定术后创伤性关节炎,可明显改善髋关节功能,有效避免骨水泥植入综合征,中期疗效满意。

Medium term follow up outcomes of uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture

Objective To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures. Methods Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively,including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared,and the position of the prosthesis through postoperative imaging at 3,6,12 months and the last follow-up were evaluated. Results One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up,14 patients regained the ability to walk independently,4 patients needed support of a cane,1 patient needed assistance of a walker. No serious complications such as joint dislocation,periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients,good in 7 and fair in 3. Conclusion Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.