RESUMEN
BACKGROUND:Artificial femoral head replacement is an effective method for the treatment of elderly unstable intertrochanteric fractures.However,the effect of lesser trochanter reconstruction in femoral head replacement for Evans-Ⅲ femoral intertrochanteric fractures has not been reported. OBJECTIVE:To analyze the effect of lesser trochanter reconstruction on the outcome of artificial femoral head replacement with long stem in elderly patients with Evans-Ⅲ femoral intertrochanteric fracture. METHODS:A retrospective analysis was performed on medical records of 45 elderly patients who underwent bipolar long-stem artificial femoral head replacement due to Evans-Ⅲ femoral intertrochanteric fractures in the Department of Bone and Joint Surgery,Second Affiliated Hospital of Xi'an Jiaotong University from June 2017 to May 2021.According to whether the small trochanter was reconstructed during surgery(reduction and fixation),they were divided into the reconstruction group(n=25)and the non-reconstruction group(n=20).The operation time,bleeding volume,time of getting out of bed,hospital stay time,Harris scores at 3 and 6 months postoperatively,and the incidence of complications during follow-up were compared between the two groups. RESULTS AND CONCLUSION:(1)The operation time of the reconstruction group was longer(99.72±13.41 minutes)than that of the non-reconstruction group(88.90±16.53 minutes)(t=2.369,P=0.023),and there were no significant differences in bleeding volume,time of getting out of bed or hospital stay time between the two groups(P＞0.05).(2)The Harris score of the reconstruction group(69.06±5.64 points)was higher than that of the non-reconstruction group(63.35±5.93 points)at 3 months postoperatively(t=2.982,P=0.005).At 6 months postoperatively,the Harris score of the reconstruction group(86.67±4.49 points)was higher than that of the non-reconstruction group(82.34±5.68 points)(t=2.782,P=0.009).(3)In addition,no significant difference existed in the incidence of complications between the reconstruction and non-reconstruction groups(χ2=0.008,P=0.927).(4)It is concluded that in elderly patients with Evans-Ⅲ femoral intertrochanteric fractures,lesser trochanter reconstruction in the artificial femoral head replacement significantly improved postoperative hip function despite increased operative time,demonstrating the importance of the lesser trochanter reconstruction in the artificial femoral head replacement for Evans-Ⅲ intertrochanteric fractures in the elderly people.
RESUMEN
Objective: To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods: Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value. Results: The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly ( t=-22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed. Conclusion: The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.