Abstract: BACKGROUND: Intertrochanteric fractures of the femur are particularly common in elderly and osteoporosis patients, and treatment often requires internal fixation surgery to stabilize the fracture and promote healing. However, internal fixation surgery may occasionally fail, leading to serious problems such as nonunion of fractures, malunion, or re-fracture.
OBJECTIVE: To explore the effect of artificial total hip arthroplasty on postoperative failure of internal fixation for intertrochanteric fractures of the femur and the influencing factors of postoperative occult blood loss.
METHODS: Totally 86 patients with failed internal fixation of intertrochanteric fractures of the femur who were treated in First People’s Hospital of Yangquan City from May 2019 to September 2022 and had complete follow-up data were collected. Using artificial total hip arthroplasty for treatment, relevant clinical indicators of the patient were recorded, and Harris score, visual analog scale score, and SF-36 score were compared and analyzed before and after surgery. Univariate and multivariate logistic regression analysis was conducted on the factors affecting occult blood loss after total hip arthroplasty. Logistic regression models and neural network models were established to predict occult blood loss. The predictive performance and accuracy of the two models were compared by drawing receiver operating characteristic curves.
RESULTS AND CONCLUSION: (1) Totally 86 patients with intertrochanteric fractures of the femur were successfully treated with artificial total hip arthroplasty after internal fixation failure. (2) There were statistically significant differences in Harris score, visual analog scale score, SF-36 score, and hip active range of motion between patients before and 3, 6, and 12 months after surgery (P < 0.05). (3) The age, hypertension ratio, diabetes ratio, osteoporosis ratio, operation time, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease in the high occult blood loss group were significantly higher than those in the low occult blood loss group (P < 0.05). The proportion of bone cement type prostheses, anterior approach, and 2-3 grade hip joint space in the low occult blood loss group were higher than those in the high occult blood loss group (P < 0.05). There was no statistically significant difference between the two groups in terms of gender ratio, body mass index, proportion of chronic bronchitis, proportion of sides, anesthesia method, and acetabular cup diameter (P > 0.05). (4) Through multivariate logistic regression analysis, age, diabetes, osteoporosis, prosthesis type, surgical approach, hip joint space, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease were the risk factors for high occult blood loss after total hip arthroplasty (P < 0.05). (5) After incorporating influencing factors into the logistic regression model and neural network model for predicting occult blood loss, the receiver operating characteristic curves of the two models were plotted with area under curve values of 0.882 and 0.923, sensitivity values of 0.879 and 0.886, specificity values of 0.854 and 0.908, Youden index values of 0.733 and 0.794, and accuracy values of 0.867 and 0.897, respectively. The area under curve, Youden index, and accuracy of both models were higher than those of neural network models. (6) It is concluded that total hip arthroplasty has a significant clinical effect on treating postoperative failure of internal fixation for intertrochanteric fractures of the femur, with good recovery of hip joint range of motion. Age, diabetes, osteoporosis, prosthesis type, surgical approach, hip joint space, total blood loss, intraoperative blood loss, postoperative drainage volume, and hemoglobin decrease are important factors for the high risk of occult blood loss after total hip arthroplasty. Logistic regression model and neural network model based on risk factors have little difference in the prediction results of occult blood loss, and neural network model is higher.  

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: intertrochanteric fracture of femur, internal fixation failure, artificial hip arthroplasty, therapeutic effect, occult blood loss