不稳定性转子间骨折PFNA术后失效行THA或内固定翻修的疗效分析

目的探讨股骨近端防旋髓内钉(PFNA)治疗不稳定性转子间骨折失败后行全髋关节置换(THA)或内固定翻修的治疗效果。方法 2013年4月—2015年7月,采用THA或内固定翻修术治疗PFNA内固定失败的不稳定性转子间骨折患者25例,其中男性10例,女性15例;年龄38~78岁,平均60.8岁;首次手术至翻修手术时间4~16周,平均7.5周。20例行THA,5例行内固定翻修治疗,术后所有患者均获得1年以上随访。结果 25例中仅2例出现并发症,经治疗后均恢复良好。术后1年髋关节Harris评分(85.6±9.2),较术前(33.4±12.5)显著提高(t=16.81,P0.05),术后1年生活质量评分指数为(87.4±7.4)较术前(65.2±10.2)显著提高(t=8.40,P0.05),术后1年疼痛VAS评分为(4.0±2.2),较术前(7.4±2.5)显著降低(t=5.11,P0.05)。结论 THA或行内固定翻修是PFNA治疗不稳定性转子间骨折失败后的有效补救措施。

THA or fixation renovation for failed internal fixation of PFNA in unstable intertrochanteric fracture

Objective To explore the clinical effect of total hip arthroplasty (THA) or fixation renovation for failed internal fixation of proximal femoral nail anti-rotation(PFNA) in unstable intertrochanteric fracture.Methods From Apr.2013 to Jul.2015,twenty-five patients were treated with THA or fixation renovation after failed fixation of PFNA.There were 10 males and 15 females,with age ranging from 38-78 years (average,60.8 years).The average interval to second operation was 7.5 weeks (range,4-16 weeks).Twenty patients accepted THA and 5 patients took fixation renovation.All of them obtained more than one year follow-up.Results Only two patients had complications,who recovered well after treatment.Compared with preoperative condition,postoperative Harris hip score was improved significantly ((33.4±12.5)points vs.(85.6±9.2)points,t=16.81,P＜0.05),postoperative quality of life score was improved significantly ((65.2±10.2)points vs.(87.4±7.4) points,t=8.40,P＜0.05),and postoperative VAS score decreased significantly ((7.4±2.5)points vs.(4.0±2.2)points,t=5.11,P＜0.05).Conclusion THA or fixation renovation is effective salvage procedure after failed internal fixation of PFNA in unstable intertrochanteric fracture.