小转子重建人工股骨头置换治疗高龄 Evans-Ⅲ 型股骨转子间骨折.

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. [ABSTRACT FROM AUTHOR]