Abstract:Objective To evaluate the clinical and radiological results of one stagetotal hip arthroplasty(THA) in the treatment ofsubtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head.Methods From June 2009 to May 2018,7 patients(7 hips) with subtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head were treated by one stage THA using an uncemented fully porous-coated long femoral stem prosthesis in our department.There were five males and two females,with an average age of (67.58±7.89)years old.According to the Seinsheimer's classification,there was 5 type ⅡB,2 type ⅢA.According to the Ficat's classification,they were all type Ⅳ.Results here were no intra-operative complications such as femoral perforations and femoral fractures.The operation time for this serieswas (111.00±29.18)min.The intraoperative blood loss was (465.00±150.45)mL.All the patients were followed up,the follow-up time was(32.00±13.56) months.At last follow-up,all patients were able to walk independently.The HHS scorewas (89.00±8.28).And according to the HHS score,it wasexcellent in 5 patients,good in 1patients,and fair in 1 patients,andthe good and excellent ratings was 85.71%.All fractures got bone union with average union time(4.30±1.03)months.All the acetablar and femoral stem showed stable prosthesis.There were no infection,deep vein thrombosis,dislocation and aspetic loosening.Conclusion One stage THA in the treatment ofsubtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head can provide a single operation that both stabilized the fracture and eliminated hip disease.An uncemented fully porous-coated long femoral stemsprovides a good intramedullary fracture stability that promotes fracture healing.
张盘军,王勇,蒋建农,朱和平,沈优. Ⅰ期全髋关节置换术治疗股骨转子下骨折合并同侧股骨头坏死[J]. 实用骨科杂志, 2020, 26(9): 778-781.
Zhang Panjun,Wang Yong,Jiang Jiannong,et al. One Stage Total Hip Arthroplasty for Subtrochanteric Femoral Fractures Combined with Ipsilateralavascular Necrosis of the Femoral Head. sygkzz, 2020, 26(9): 778-781.
[1]Joglekar SB,Lindvall EM,Martirosian A.Contemporary management of subtrochanteric fractures[J].Orthop Clin N Am,2015,46(1):21-35.
[2]Egol KA.Subtrochanteric femur fracture below an arthritic hip:Opinion:Open reduction and internal fixation in conjunction with total hip arthroplasty[J].J Orthop Trauma,2005,19(1):60-61.
[3]Koval KJ.Subtrochanteric femur fracture below an arthritic hip:Opinion:Open reduction and internal fixation[J].J Orthop Trauma,2005,19(1):61-62.
[4]蒋垚,张先龙,沈璟,等.全髋人工关节置换术治疗股骨转子下骨折伴股骨头缺血性坏死[J].中华创伤杂志,2005,21(11):811-814.
[5]Oztürkmen Y,Uzümcügil O,Sükür E,et al.The use of a cementlessmodularstem in the treatment of subtrochantericfemoralfractures in conjunction with ipsilateralcoxarthrosis[J].Orthopedics,2011,34(1):13.
[6]Gallagher CA,Jones CW,Kimmel L,et al.Osteoarthritis is associated with increased failure of proximal femoral fracture fixation[J].Int Orthop,2019,43(5):1223-1230.
[7]Mont MA,Salem HS,Piuzzi NS,et al.Nontraumatic osteonecrosis of the femoral head:where do we stand today? A 5-year update[J].J Bone Joint Surg(Am),2020,102(12):1084-1099.
[8]Neumann D,Thaler C,Dorn U.Management of Vancouver B2 and B3 femoral periprosthetic fractures using a modular cementless stem withoutallografting[J].In Orthop,2012,36(5):1045-1050.
[9]DeLee JG,Charnley J.Radiological demarcation of cemented sockets in total hip replacement[J].Clin Orthop Relat Res,1976(121):20-32.
[10]Kim YH,Kim VE.Uncemented porous-coated anatomic total hip replacement.Results at six years in a consecutive series[J].J Bone Joint Surg (Br),1993,75(1):6-13.
[11]Engh CA,Massin P,Suthers KE.Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components[J].Clin Orthop Relat Res,1990(257):107-128.
[12]Zheng H,Gu H,Shao H,et al.Treatment and outcome of Vancouver type B periprosthetic femoral fractures[J].Bone Joint J,2020,102B(3):293-300.
[13]Lewis PM,Olsen M,Schemitsch EH,et al.Echelon stems and primary total hip replacementsurgery[J].Orthopedics,2008,31(12 Suppl 2):100-105.
[14]Egan KJ,Di Cesare PE.Intraoperative complications of revision hip arthroplasty using a fully-coated straight cobalt-chrome femoral stem[J].J Arthroplasty,1995,10(Suppl 1):S45-S51.
[15]Issack PS,Guerin J,Butler A,et al.Intraoperative complications of revision hip arthroplasty using a porous-coated,distallyslotted,fluted femoral stem[J].Clin Orthop Relat Res,2004(425):173-176.