人工关节置换翻修老年股骨粗隆内固定术后失效的近期临床疗效

目的：探讨人工关节翻修治疗老年骨质疏松患者股骨粗隆骨折内固定术后失效的近期临床效果。方法：选取2010 年1月至2020 年1月期间在温州医科大学附属第二医院治疗且随访资料完整的股骨粗隆骨折内固定失效患者，采用人工关节置换术进行治疗。记录患者相关临床指标及并发症，比较患者术前术后的髋关节Harris评分以及VAS评分。结果：本组病例共纳入20 例患者，其中男14 例，女6 例，年龄65～85（74.7±5.8）岁。所有患者均顺利完成手术，平均手术时间为（113.5±16.3）min，平均出血量为（687.5±304.3）mL。术后2 例患者出现肺部感染，1例患者出现心功能衰竭，经内科相关处理后均好转；1例患者出现浅表性感染，经口服抗生素，创口换药后好转愈合。在后期门诊随访中，出现1例假体周围骨折，其余均未出现假体松动，假体下沉，假体不稳定，关节深部感染，关节脱位等并发症。本组患者术前髋关节Harris评分为（39.4±6.8）分，末次随访的髋关节Harris评分为（85.7±4.3）分；术前VAS评分为（7.2±1.0）分，末次随访VAS评分为（1.6±0.5）分；术前SF-36评分为（43.6±7.9）分，末次随访为（84.5±4.1）分。三项评分均明显改善（P ＜0.05）。结论：人工关节置换翻修治疗老年骨质疏松性股骨粗隆间骨折内固定术后失效，近期临床效果显著，可有效减少患者髋关节疼痛，恢复髋关节功能。

Short-term clinical effect of artificial joint replacement in the treatment of the elderly after failure of femoral trochanteric internal fixation

Objective: To investigate the short-term clinical effect of artificial joint replacement after failure of internal fixation of femoral trochanteric fracture in elderly osteoporosis patients. Methods: The patients with internal fixation failure of femoral trochanteric fracture who were treated at the Second Affiliated Hospital of Wenzhou Medical University between January 2010 and January 2020 with complete follow-up data were selected and treated with artificial joint replacement. Relevant clinical indicators and complications of patients were recorded, and Harris score and VAS score of hip joint of patients before and after operation were compared.Results: A total of 20 patients were included, including 14 males and 6 females, with an age range from 65 to 85 years (mean age, 74.7±5.8 years old). All patients successfully underwent the operation, with a mean operation time of (113.5±16.3)min, and the bleeding volume was (687.5±304.3)mL. Two patients suffered pulmonary infection and 1 patient had heart failure after surgery but improved with relevant medical treatment. One patient developed superficial infection, and the wound healed after oral antibiotics and dressing change. In the followup,there was one case of periprosthetic fracture, and the rest had no complications such as prosthesis loosening,prosthesis sinking, prosthesis instability, deep joint infection, joint dislocation, etc. Harris score of the hip joint of the patients in this group was 39.4±6.8 before operation, and 85.7±4.3 in the last follow-up. The preoperative VAS score was 7.2±1.0, and the final follow-up VAS score was 1.6±0.5. The preoperative SF-36 score was 43.6±7.9,and the final follow-up score was 84.5±4.1. All the three scores were significantly improved (P<0.05). Conclusion:Artificial joint replacement is an effective treatment for elderly patients with osteoporotic femoral intertrochanteric fracture who experience failure of internal fixation after surgery, with a significant short-term clinical effect that can effectively reduce hip joint pain and restore hip joint function.