Hemiarthroplasty and reconstruction of the greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients

doi:10.3969/j.issn.2095-4344.0224

Abstract

Abstract:

BACKGROUND: Many domestic and foreign literatures have reported that half hip replacement for unstable intertrochanteric fractures in the elderly has achieved good results, but the unstable intertrochanteric fracture with hemiarthroplasty is difficult to reconstruct the greater trochanter, and its reconstruction method is still controversial.

OBJECTIVE: To discuss short-term effect of bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients.

METHODS: Clinical data of 15 elderly patients with intertrochanteric fracture undergoing bipolar hemiarthroplasty, and reconstruction of the femoral greater trochanter with cerclage band in the Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed. Posterolateral approach was selected. The patients were followed up in out-patient clinic yearly at postoperative 1, 3, 6 and 12 months. Fracture healing was judged using X-ray films, and the possibility of infection was observed. Hip function was evaluated using Harris scoring. Subjective satisfaction of patients was recorded.

RESULTS AND CONCLUSION: (1) All patients walked within 3 days after operation. All patients were reviewed on time within a year. Postoperative X-ray revealed that the sample achieved initial stability, and had achieved fracture healing of greater trochanter. Blood examination did not show infection index. (2) The Harris score was (86.3±5.8) in final follow-up. Subjective satisfaction of patients was good. (3) In summary, bipolar hemiarthroplasty and reconstruction of the femoral greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients can obtain good therapeutic effect, and it can achieve good prosthesis stability and large trochanter fracture reduction and fixation.

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: Arthroplasty, Replacement, Hip, Femoral Fractures, Prosthesis Implantation, Tissue Engineering

CLC Number:

R318

Zhao Qing-bin, Wang Li, Ha Baxi•Kaken, Zhao Wei, Yuan Hong. Hemiarthroplasty and reconstruction of the greater trochanter with cerclage band in the treatment of intertrochanteric fracture in elderly patients [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2309-2314.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，共纳入15例转子间骨折患者，全部进入结果分析，无脱落。试验流程图见图1。 2.2 临床疗效本组患者髋关节Harris评分从置换前平均(16.4±11.9)分，提高至末次随访的(86.3±5.8)分，差异有显著性意义(t=-36.594，P < 0.001)。4髋评分为优，8髋为良，3髋为可。术后2例在活动后出现大转子区轻度疼痛，休息后可缓解。末次随访时6例患者的髋关节外展肌肌力达到5级，4例为4级，3例为3级。5例残留轻度跛行，为外展肌肌力为3级(3例)和4级(2例)者。2例患者对手术疗效较不满意，其中跛行1例，活动度差1例，其余13例表示非常满意或比较满意。 2.3 影像学评价根据Callaghan等的标准，术后X射线片示假体位置佳，无松动、下沉及脱位，股骨近端无骨溶解或骨吸收，无骨折复位后再移位，无捆绑带断裂松动迹象发生。1例术后出现异位骨化(BrookerⅠ级)，均位于大转子与髂骨翼之间。异位骨化未对临床疗效产生显著影响，故未予特殊干预。 2.4 并发症本组患者出现医源性坐骨神经损伤1例，未见脱位、感染及松动病例。医源性坐骨神经损伤患者采用神经营养药物、物理治疗和踝关节背伸支具治疗，在术后1年部分恢复。1例术后出现下肢肌间隙血栓形成，给予患者利抗栓治疗7 d后改为利伐沙班片抗栓治疗，1个月后血栓消失，未发生肺栓塞及生命危险。大转子骨不连有14髋获得骨性愈合，仅有1例在骨折块与大转子主体结构间存在透亮带，但未见骨折块的明显移位(<1 cm)，未见捆绑带断裂，也未出现大转子区的疼痛症状，故认为是稳定的纤维固定。 2.5 典型病例典型病例1：患者75岁，女性，诊断为左股骨转子间骨折、老年性痴呆，入院当天完善检查后急诊在连续硬膜外麻醉下行左股骨转子间骨折人工双动头髋关节置换，随访时间6个月，末次随访髋关节Harris评分87分，见图2。典型病例2：患者85岁，女性，诊断为左股骨转子间骨折、高血压3级、冠状动脉粥样硬化性心脏病，入院当天完善检查后急诊在连续硬膜外麻醉下行左股骨转子间骨折人工双动头髋关节置换，随访时间12个月，末次随访髋关节Harris评分83分，见图3。"

References

[1] Sciacca S, Lidder SS, Grechenig C, et al.Variations of treatment in selected proximal femur fractures among surgeons with different surgical experience--A survey at an international AO course.Injury. 2015;46(6):S57-60.

[2] Mäkinen TJ, Gunton M, Fichman SG, et al.Arthroplasty for pertrochanteric hip fractures. Orthop Clin North Am. 2015; 46(4):433-444.

[3] 凡福成,桂斌捷. 老年股骨粗隆间骨折行伽玛钉固定与人工关节置换的疗效对比[J]. 中国矫形外科杂志, 2016,24(2):174-177.

[4] Cruz-Sánchez M, Torres-Claramunt R, Alier-Fabregó A, et al. Salvage for nail breakage in femoral intramedullary nailing. Injury. 2015;46(4):729-733.

[5] Choy WS, Ahn JH, Ko JH, et al. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Clin Orthop Surg. 2010;2(4):221-226.

[6] Sidhu AS, Singh AP, Singh AP, et al. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop. 2010;34(6):789-792.

[7] Chang JD, Kim IS, Lee SS, et al. Unstable intertrochanteric versus displaced femoral neck fractures treated with cementless bipolar hemiarthroplasty in elderly patients; a comparison of 80 matched patients. Orthop Traumatol Surg Res. 2016;102(6):695-699.

[8] Desteli EE, ?mren Y, Erdo?an M, et al. Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in Elderly.Clin Invest Med. 2015;38(2):E63-72.

[9] Sidhu AS,Singh AP,Singh AP,et al.Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.Int Orthop.2010;34: 789-792.

[10] Laffosse JM,Molinier F,Tricoire JL,et al.Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients.Acta Orthop Belg. 2007;73: 729-736.

[11] Müller F, Galler M, Zellner M, et al. The fate of proximal femoral fractures in the 10th decade of life: an analysis of 117 consecutive patients. Injury. 2015;46(10):1983-1987.

[12] 姜旭,徐辉. 股骨大粗隆重建的人工关节置换治疗高龄不稳定型粗隆间骨折[J].中国骨与关节杂志,2013,2(1) :25-29.

[13] Baril Y, Bourgeois Y, Brailovski V, et al. Improving greater trochanteric reattachment with a novel cable plate system. Med Eng Phys. 2013;35(3):383-391.

[14] Thakur NA, Crisco JJ, Moore DC, et al. An improved method for cable grip xation of the greater trochanter after trochanteric slide osteotomy. J Arthroplasty. 2010;25(2): 319-324.

[15] Yun HH, Lee YI, Kim KH,et al. Use of auxiliary locking plates for the treatment of unstable pertrochanteric femur fractures. Orthopedics.2015;38(5):305-309.

[16] 姜旭,徐辉. 大粗隆爪钢板结合全髋关节置换术治疗陈旧性股骨粗隆间骨折12例中期随访报告[J].中国骨与关节杂志,2016,5(4): 297-301.

[17] Im GI, Lee SH. Wiring through cannulated screws for the fixation of greater trochanter in arthroplasties performed forperitrochanteric fractures. J Arthroplasty. 2006;21(3): 449-451.

[18] Singh S, Shrivastava C, Kumar S. Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur. J Clin Diagn Res. 2014;8(10): LC01-LC04.

[19] Huffman GR, Ries MD. Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg Am. 2003; 85-A(2):273-277.?

[20] 中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华关节外科杂志:电子版,2009,3(3)：380-383.

[21] Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture-treatment by mold arthroplasty: and end- result study using a new method of result evaluation. J Bone Jonit Surg (Am). 1969;51(4):737-755.

[22] Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17-27.

[23] Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis: two-year results of a prospective consecutive series. J Bone Joint Surg Am. 1988;70(3):337-346.

[24] Zarin JS, Zurakowski D, Burke DW. Claw plate fixation of the greater trochanter in revision total hip arthroplasty. J Arthroplasty. 2009; 24(2):272-280.

[25] Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classi cation. J Bone Joint Surg Am. 1973;55(8): 1629-1632.

[26] Harris WH, McCarthy JC Jr, O’Neill DA.Femoral component loosening using contemporary techniques of femoral cement fixation.J Bone Joint Surg Am. 1982;64: 1063 -1067.

[27] 黄志勇,罗剑,尹国栋. PFNA和人工双极股骨头置换术治疗老年性股骨粗隆间骨折的疗效比较[J].创伤外科杂志, 2016,18(12): 738-741.

[28] 刘朋,张力. PFNA内固定与髋关节置换治疗老年股骨粗隆间骨折的Meta分析[J].中国老年学杂志,2015,35(5):1186-1189.　

[29] 刘潮坚,蔡拉加,石昭宏.半髋置换加钢丝环扎术在高龄不稳定粗隆间骨折的应用[J].创伤外科杂志,2016,18(5):281-283.

[30] 张明强.生物型加长柄半髋关节置换术治疗高龄不稳定股骨转子间骨折疗效观察[J]．中医正骨,2015,5(2):56-57.

[31] Fichman SG, Mäkinen TJ, Safir O, et al. Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing. Int Orthop. 2016;40:15–20.

[32] Sinno K, Sakr M, Girard J, et al.The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients.N Am J Med Sci. 2010;2(12): 561-568.

[33] Kim Y, Moon JK, Hwang KT, et al. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians. Acta Orthop Traumatol Turc. 2014;48(4): 424-430.

[34] Kumar Gn K, Meena S, Kumar NV, et al. Bipolar hemiarthroplasty in unstable intertrochanteric fractures in elderly: a prospective study. J Clin Diagn Res. 2013;7(8): 1669-1671.

[35] Deleanu B, Prejbeanu R, Crisan D,et al. Combined bilateral femoral head necrosis and pertrochanteric fracture: a case report.J Med Case Rep. 2015;9:25.

[36] Dall DM, Miles AW. Re-attachment of the greater trochanter: the use of the trochanter cable-grip system. J Bone Joint Surg Br. 1983;65(1):55-59.?

[37] Weller I, Wai EK, Jaglal S, et al.The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005;87(3): 361-366.

[38] Strohm PC, Raschke M, Hoffmann R,et al. Hip fracture prosthetics in German trauma surgery. State of the art. Unfallchirurg. 2015;118(2):173-176.

[39] Eriksson M, Kelly-Pettersson P, Stark A, et al. 'Straight to bed' for hip-fracture patients: a prospective observational cohort study of two fast-track systems in 415 hips. Injury. 2012; 43(12):2126- 2131.?

[40] Alarcón T, González-Montalvo JI, Mauleon JL, et al.Delay surgical treatment of hip fracture: continuing problems.Rev Esp Salud Publica. 2015;89(1):117-118.