Bipolar femoral head replacement for unstable femoral intertrochanteric fracture in elderly patients: hip joint function and complications

doi:10.3969/j.issn.2095-4344.2015.26.004

Abstract

Abstract:

BACKGROUND: In elderly patients with unstable intertrochanteric fracture, because of poor general condition and poor bone condition, on one hand, the internal fixation of fracture may lead to nonunion. On the other hand, patients still need longer time in bed and hip joint fixation, and may result in complications of long-term bed rest. Artificial femoral head replacement is a safe operation mode, can solve the problem of early ambulation of patients.
OBJECTIVE: To observe the repair effect of bipolar artificial femoral head replacement on unstable femoral intertrochanteric fracture in elderly patients.
METHODS: A total of 39 elderly patients with unstable femoral intertrochanteric fractures, who were treated in the Department of Orthopedics, 101 Hospital of Chinese PLA from 2005 to 2014, were enrolled in this study. There were 21 males and 18 females, at the age of 80-96 years old, averagely 85 years old. They all received bipolar artificial femoral head replacement. Harris score was measured to assess hip joint function at 1 year after replacement. The incidence of complications was recorded.
RESULTS AND CONCLUSION: A total of 39 cases were followed up for 1-5 years. The wound of all patients was healed in the primary stage. No cardiovascular or cerebrovascular accident appeared. All patients passed safely through the perioperative period. No severe complications occurred. Hip joint function was assessed according to Harris score at 1 year after replacement: excellent in 13 cases, good in 20 cases, average in 4 cases, poor in 2 cases, with an excellent and good rate of 85%. No dislocation appeared. The results suggest that bipolar artificial femoral head replacement can be used to treat femoral intertrochanteric fracture in elderly patients. The postoperative recovery time was short; bleeding was less; complications were few. Hip joint function recovered well. For elderly patients with femoral intertrochanteric fracture, bipolar artificial femoral head replacement is an ideal safe effective repair method.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Femoral Fractures, Hip Prosthesis, Follow-Up Studies

CLC Number:

R318

Tan Zhang-yong, Wang Jian-liang, Guo Feng, Xu Ke-feng. Bipolar femoral head replacement for unstable femoral intertrochanteric fracture in elderly patients: hip joint function and complications [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(26): 4118-4122.

Figures/Tables 2

References

[1] 郑红根,唐昊,张秋林.2种不同内固定治疗股骨粗隆间骨折的比较研究[J].中国矫形外科杂志,2009,17(6):407-410.
[2] Leung KS,So WS,Shen WY,et al.Gamma nail and dynamic hip screws for peritrochanteric fractures:a randomized prospective study in elderly patients.J Bone Joint Surg Br. 1992;74:345-351.
[3] Parker MJ, Handoll HH.Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults.Cochrane Database Syst Rev. 2010; (9):CD000093.
[4] 陈于东.转子间骨折内固定失效因素分析及防治策略[J].中医正骨,2014,27(2):60-62.
[5] 尚松,蒋赞利.股骨转子间骨折内固定失败的相关危险因素分析[J].东南大学学报(医学版),2013,32(3):324-327.
[6] Parker MJ, Khan RJ, Crawford J, et al.Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients.J Bone Joint Surg Br. 2002;84(8):1150-1155.
[7] 文奇,刘彦荣,王坤正.双动人工股骨头置换治疗高龄股骨转子间骨折32例[J].陕西医学杂志,2008,37(6):716-718.
[8] Ho M, Garau G, Walley G, et al.Minimally invasive dynamic hip screw for fixation of hip fractures.Int Orthop. 2009;33(2): 555-560.
[9] Dujardin FH, Benez C, Polle G, et al.Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results.J Orthop Trauma. 2001; 15(6):401-406.
[10] 赵洪曾,徐秋玉,曾勉东,等.老年股骨粗隆间骨折股骨近端锁定板与动力髋螺钉内固定治疗比较[J].中国矫形外科杂志,2011, 19(10):795-796.
[11] 龙显斌,曹盛俊,廖瑛,等.内固定手术治疗老年人股骨粗隆间骨折的临床分析[J].中国骨伤,2007,20(2):116-117.
[12] 李奇志,李增炎.老年股骨转子间骨折的治疗进展[J].中国老年学杂志,2008,28(13):1345-1347.
[13] Kim WY,Han CH,Park JI,et al.Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;6:360-362.
[14] Knobe M,Munker R,Sellei RM,et al.Unstable pertrochanteric femurfractures.Failure rate,lag screw sliding and outcome with extra and intramedullary devices(PCCP,DHSand PFN).Z Orthop Unfall. 2009;3:306-313.
[15] Mnif H, Koubaa M, Zrig M,et al.Elderly patient's mortality and morbidity following trochanteric fracture. A prospective study of 100 cases.Orthop Traumatol Surg Res. 2009;95(7): 505-510.
[16] Madsen JE, Naess L, Aune AK, et al.Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw. J Orthop Trauma. 1998; 12(4):241-248.
[17] Saudan M, Lübbeke A, Sadowski C,et al.Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail.J Orthop Trauma. 2002;16(6):386-393.
[18] Huang X, Leung F, Xiang Z,et al.Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials. Sci World J. 2013; 2013:805.
[19] Parker MJ, Handoll HH.Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010; (9):CD000093.
[20] 陈德喜,万修阳,狼继孝,等.高龄股骨粗隆间骨折不稳定型骨折不同手术方式比较[J].中国矫形外科杂志,2006,14(6):431-433.
[21] 叶一林,柴卫兵,朱天岳,等.股骨粗隆间骨折内固定手术后并发症原因分析[J] .中国矫形外科杂志，2005,13(12):890-892.
[22] 曹列虎,刘新伟,苏佳灿,等.应用动力髋螺钉、Gamma钉与股骨近端髓内钉治疗高龄患者股骨转子间骨折：随即、前瞻设计95例随访分析[J] .中国组织工程研究与临床康复,2009, 13(17): 3342-3346.
[23] 李峰,张克,田华,等.髋部骨折内固定失败后的挽救性人工关节置换治疗[J] .中国骨与关节损伤杂志,2010,25(12):1100-1101.
[24] Zhao Y, Fu D, Chen K, et al.Outcome of hemiarthroplasty and total hip replacement for active elderly patients with displaced femoral neck fractures: a meta-analysis of 8 randomized clinical trials.PLoS One. 2014; 9(5):e98071.
[25] 李文强,吕尚军.水泥型双动半髋关节置换术治疗老年股骨转子间骨折[J].中医正骨,2010,22(4):37-38.
[26] Keating JF, Grant A, Masson M, et al.Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.Health Technol Assess. 2005; 9(41):iii-iv, ix-x, 1-65.
[27] 雷金来,秦四清,斐琦,等.带大粗隆人工关节置换治疗高龄不稳定股骨粗隆间骨折132例[J].中国骨与关节损伤杂志,2011,26:(8): 717-718.
[28] 赵得伟,赵杰,郭林,等.同期与分期小切口双侧全髋关节置换临床比较分析[J] .中国骨与关节损伤杂志,2010,25(8):682-685.
[29] Kim SY, Kim YG, Hwang JK.Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study.J Bone Joint Surg Am. 2005;87(10): 2186-2192.
[30] Parker MJ, Handoll HH. Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults.Cochrane Database Syst Rev. 2006; (2):CD000086.
[31] Sadowski C, Lübbeke A, Saudan M, et al.Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg Am. 2002; 84-A(3):372-381.
[32] 赵资坚,邹育才,刘梦璋,等.股骨粗隆重建加长柄人工股骨头置换治疗老年股骨粗隆间粉碎性骨折[J].中国骨与关节损伤杂志，2011,26(4):331-332.
[33] 睦佳,康一凡,沈峰,等.BetaCupTM髋臼系统在全髋关节置换术中的应用[J].中国骨与关节损伤杂志,2011,26(4):322-323.
[34] 罗树林,伊峰,沈彬,等.髋臼发育不良伴股骨头坏死三种全髋关节置换术式的治疗体会[J].中国骨与关节损伤杂志,2011,26（8）：720-721.