人工股骨头置换治疗高龄患者股骨转子间骨折髓内钉失效的手术时机选择

目的:分析高龄患者股骨转子间骨折髓内钉失效后行人工股骨头置换术的手术时机选择。方法：2013年7月至2019年9月，采用人工股骨头置换术治疗股骨转子间骨折髓内钉固定失效后的17例高龄患者，根据从确诊内固定失效到行人工股骨头置换术的间隔时间将患者分为早期手术和延期手术两组。其中，早期手术组8例，男5例，女3例；年龄80~89（84.88±2.79）岁；间隔1~7（4.13±1.73） d。延期手术组9例，男4例，女5例；年龄80~89（84.22±3.03）岁；间隔15~30（25.56±4.36） d。比较两组患者手术时间、术中失血量、术后首次下地负重时间、术后住院时间、并发症例数及死亡例数。术后1、12个月采用Harris评分评价髋关节功能。结果：术后患者切口愈合良好，早期手术组泌尿道感染1例；延期手术组中，肌间静脉血栓2例，肺部感染1例，泌尿道感染3例，假体脱位1例。17例患者均获随访，时间12~16（14.76±1.86）个月。两组手术时间、术中失血量、死亡例数比较差异无统计学意义（P>0.05）；两组术后首次下地负重时间、术后住院时间、并发症例数比较，差异有统计学意义（P<0.05）。术后1个月两组患者Harris评分比较，差异有统计学意义（P<0.05）；术后12个月两组患者Harris评分比较，差异无统计学意义（P>0.05）。结论：高龄患者股骨转子间骨折髓内钉固定失效后，早期手术同延期手术相比，其死亡率及最终髋关节功能无明显差异，但早期行人工股骨头置换术能够让患者更早下地负重，缩短住院时间，有效减少并发症率，尽快恢复髋关节功能。

Timing of artificial femoral head replacement in the treatment of femoral intertrochanteric fracture with intramedullary nail failure in elderly patients

Objective: To analyze the timing of artificial femoral head replacement in elderly patients with femoral intertrochanteric fracture after intramedullary nail failure.Methods: From July 2013 to September 2019, 17 elderly patients with femoral intertrochanteric fracture after intramedullary nail fixation failure were treated with artificial femoral head replacement. According to the interval from diagnosis of internal fixation failure to pedestrian femoral head replacement, the patients were divided into early operation and delayed operation groups. Among them, there were 8 cases of early operation, 5 males and 3 females;the age ranged from 80 to 89 years old with an average of (84.88±2.79) years old;the interval was 1 to 7 days with an average of(4.13±1.73) d. There were 9 cases of delayed operation, 4 males and 5 females;the age ranged from 80 to 89 year old with an average of(84.22±3.03) years old;The interval was 15 to 30 with days an average of (25.56±4.36) d. The operation time, intraoperative blood loss, the first postoperative weight-bearing time, postoperative hospital stay, the number of complications and deaths were compared between two groups. Harris score was used to evaluate hip function at 1 and 12 months after operation.Results: The incision healed well after operation. There was 1 case of urinary tract infection in the early operation group;in the delayed operation group, there were 2 cases of intermuscular venous thrombosis, 1 case of pulmonary infection, 3 cases of urinary tract infection and 1 case of prosthesis dislocation. All 17 patients were followed up for 12 to 16 months with an average of (14.76±1.86) months. There was no significant difference in operation time, intraoperative blood loss and the number of deaths between two groups(P>0.05). There were significant differences in the first weight-bearing time, postoperative hospital stay and the number of complications between two groups(P<0.05). One month after operation, there was significant difference in Harris score between two groups(P<0.05). There was no significant difference in Harris score between two groups 12 months after operation(P>0.05).Conclusion: After the failure of intramedullary nail fixation of femoral intertrochanteric fracture in elderly patients, there is no significant difference in mortality and final hip function between early operation and delayed operation. However, early pedestrian femoral head replacement can make patients go down to the ground earlier, shorten the length of hospital stay, effectively reduce the complication rate and restore hip function as soon as possible.