Early clinical evaluation of direct anterior minimally surgery hemi arthroplasty for advanced age patients with Evans type Ⅰ intertrochanteric fractures
Liu Hongyang1, Xu Hongjia2, Liang Junsheng1
1Department of Geriatric Orthopedics, the 2nd Hospital of Tangshan, Tangshan 063000, China; 2Institute of Occupational Health Control, the Center for Disease Control and Prevention, Tangshan 063000, China
Abstract：Objective To investigate the early clinical efficacy of direct anterior minimally invasive surgery (DAMIS) hemi arthroplasty in the treatment of intertrochanteric fractures in elderly patients (Evans type Ⅰ). Methods A retrospective cohort study was performed on 100 elderly patients with Evans type Ⅰ intertrochanteric fracture who had undergone surgical treatment in Tangshan Second Hospital from December 2017 to December 2021. The patients were 39 males and 61 females aged 80-91 years. Through different surgical methods, 45 cases were treated with DAMIS hemi arthroplasty (joint replacement group), and 55 cases were treated with proximal femoral nail anti-rotation (PFNA) internal fixation (internal fixation group). In accordance with the fracture end type, the patients were divided into stable (n=50) and unstable (n=50) groups. Baseline data, such as age, gender, body mass index, bone mineral density, and preoperative Harris score, were compared between the joint replacement and internal fixation groups. The operation time, intraoperative blood loss, postoperative weight-bearing time, postoperative complications, implant complications, and Harris score at different time points (2 weeks, 6 weeks, 3 months, and 9 months after the operation) were compared between the stable and unstable groups. Postoperative follow-up was also performed to observe bone healing and whether any complications, such as loosening and fracture of the internal fixators, occurred. Results All patients were followed up for 9-12 months. No wound infection or poor wound healing occurred after operation. (1) No significant difference was observed in the basic data between the joint replacement and internal fixation groups (all P values>0.05). (2) In the stable group, no significant difference in operation time and intraoperative blood loss was observed between Compared with patients with internal fixation, those the two types of operations (all P values>0.05). with joint replacement had shorter incision length (9.6 [9.3, 9.9] cm vs. 11.0 [10.3, 11.6] cm), earlier weight-bearing time (2.0 [2.0, 3.0] d vs. 11.0 [9.0, 12.8] d), and a higher Harris score at different time points after surgery. The differences were statistically significant (all P values<0.01). In the unstable group, no significant differences in operation time, intraoperative blood loss, and incision length were found between the two types of operations (all P values>0.05). Compared with patients with internal fixation, those with joint replacement had earlier weight-bearing time (2.0 [2.0, 3.0] d vs. 87.0 [79.0, 95.0] d) and a higher Harris score at different time points after surgery, and the differences were statistically significant (all P values<0.01). (3) In the internal fixation group, the bone healing standard was reached about 1.5-6.0 months after the operation. No loosening or fracture of the internal fixator occurred. In the joint replacement group, no prosthesis loosening, prosthesis dislocation, and periprosthetic fracture were observed. One patient had symptoms of lateral femoral cutaneous nerve palsy, which completely disappeared about six months after the operation. Conclusion DAMIS hemi arthroplasty for Evans Type Ⅰ intertrochanteric fracture in elderly patients has the advantages of small incision, early weight-bearing time, high Harris score, and good early clinical efficacy.
刘弘扬, 许弘佳, 梁俊生. 微创直接前侧入路半髋关节置换术治疗高龄Evans Ⅰ型股骨转子间骨折患者的早期疗效观察[J]. 中华解剖与临床杂志, 2022, 27(12): 817-822.
Liu Hongyang, Xu Hongjia, Liang Junsheng. Early clinical evaluation of direct anterior minimally surgery hemi arthroplasty for advanced age patients with Evans type Ⅰ intertrochanteric fractures. Chinese Journal of Anatomy and Clinics, 2022, 27(12): 817-822.
Koval KJ, Aharonoff GB, Rokito AS, et al.Patients with femoral neck and intertrochanteric fractures. Are they the same?[J]. Clin Orthop Relat Res, 1996(330):166-172. DOI: 10.1097/00003086-199609000-00020
[2]
Li J, Cheng L, Jing J.The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J]. Orthop Traumatol Surg Res, 2015,101(2):143-146. DOI: 10.1016/j.otsr.2014.12.011
[3]
Cankaya D, Ozkurt B, Tabak AY.Cemented calcar replacement versus cementless hemiarthroplasty for unstable intertrochanteric femur fractures in the elderly[J]. Ulus Travma Acil Cerrahi Derg, 2013,19(6):548-553. DOI: 10.5505/tjtes.2013.57615
[4]
Chen J, Yue C, He P, et al.Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: a systematic review and meta-analysis (PRISMA)[J]. Medicine (Baltimore), 2021,100(9):e24166. DOI: 10.1097/MD.0000000000024166
[5]
Cui Q, Liu YS, Li DF, et al.Cemented hip hemiarthroplasty clinical observations on unstable intertrochanteric fracture in elderlies[J]. Eur J Trauma Emerg Surg, 2016,42(5):651-656. DOI: 10.1007/s00068-015-0566-0
[6]
Kim JT, Kim HH, Kim JH, et al.Mid-term survivals after cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients[J]. J Arthroplasty, 2018,33(3):777-782. DOI: 10.1016/j.arth.2017.10.027
[7]
李骏然, 李力更, 翟婧秀, 等. 微创直接前侧入路与后外侧入路全髋关节置换术治疗老年人股骨颈骨折的早期临床疗效对照研究[J].中华解剖与临床杂志,2021,26(2):182-187. DOI: 10.3760/cma.j.cn101202-20200524-00170Li JR, Li LG, Zhai JX, et al.Comparison of early functional recovery between direct anterior minimally invasive surgery and posterolateral approach for total hip arthroplasty in the treatment of femoral neck fracture in the elderly[J].Chin J Anat Clin,2021,26(2):182-187. DOI: 10.3760/cma.j.cn101202-20200524-00170
[8]
中华预防医学会. 中国高龄老年人血压水平适宜范围指南[J].中华疾病控制杂志,2021,25(3):249-256,372. DOI: 10.16462/j.cnki.zhjbkz.2021.03.001Chinese Preventive Medical Association. Guideline on optimal blood pressure range for Chinese oldest old[J]. Chinese Journal of Disease Control and Prevention,2021,25(3):249-256,372. DOI: 10.16462/j.cnki.zhjbkz.2021.03.001
[9]
Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969,51(4):737-755
[10]
秦啸龙, 张先龙, 蒋垚, 等. 股外侧皮神经的手术安全区与前侧入路微创全髋关节置换术切口的选择[J].中华关节外科杂志(电子版),2008,2(3):263-267. DOI: 10.3969/j.issn.1674-134X.2008.03.006Qin XL, Zhang XL, Jiang Y, et al.Surgery safe zone of later femoral cutaneous nerve region and skin incision choice of minimally invasive surgery of total hip arthroplasty with anterior surgery approach[J]. Chin J Joint Surg(Electronic Edition), 2008,2(3):263-267. DOI: 10.3969/j.issn.1674-134X.2008.03.006
[11]
Xie Y, Zhou H.Primary cemented hemiarthroplasty for unstable intertrochanteric fractures in elderly severe osteoporotic patients[J]. Injury, 2020,51(3):670-673. DOI: 10.1016/j.injury.2020.01.010
[12]
Haidukewych GJ.Intertrochanteric fractures: ten tips to improve results[J]. Instr Course Lect, 2010,59:503-509
[13]
Megas P, Kaisidis A, Zouboulis P, et al.Comparative study of the treatment of pertrochanteric fractures--trochanteric gamma nail vs. proximal femoral nail[J]. Z Orthop Ihre Grenzgeb, 2005,143(2):252-257. DOI: 10.1055/s-2005-836453
[14]
Ostojić Z, Moro G, Kvesić A, et al. Treatment of peritrochanteric fractures by the use of gamma nail[J]. Coll Antropol, 2010,34 Suppl 1:243-246
[15]
Pho RW, Nather A, Tong GO, et al.Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient[J]. J Trauma, 1981,21(9):792-797. DOI: 10.1097/00005373-198109000-00007
[16]
Yuan BJ, Abdel MP, Cross WW, et al.Hip arthroplasty after surgical treatment of intertrochanteric hip fractures[J]. J Arthroplasty, 2017,32(11):3438-3444. DOI: 10.1016/j.arth.2017.06.032
[17]
陈先武, 叶如卿, 徐海平. Wagner SL股骨柄治疗陈旧性或伴髋关节炎的股骨粗隆间骨折疗效观察[J].中国骨伤,2017,30(3):264-269. DOI: 10.3969/j.issn.1003-0034.2017.03.016Chen XW, Ye RQ, Xu HP.Clinical outcomes of total hip arthroplasty using Wagner SL revision stem in femoral intertrochanteric fractures for patients with old fracture or painful arthritis before injury[J]. Zhongguo Gu Shang, 2017,30(3):264-269. DOI: 10.3969/j.issn.1003-0034.201703.016
[18]
邓闽军, 孙振国, 闵继康, 等. 生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的中期疗效分析[J].中国骨伤,2020,33(4):322-326. DOI: 10.12200/j.issn.1003-0034.2020.04.007Deng MJ, Sun ZG, Min JK, et al.Medium-term efficacy of bio-lengthened stem arthroplasty in the treatment of unstable intertrochanteric femoral fractures in elderly patients[J]. Zhongguo Gu Shang, 2020,33(4):322-326. DOI: 10.12200/j.issn.1003-0034.2020.04.007
[19]
Stähelin T, Drittenbass L, Hersche O, et al.Failure of capsular enhanced short external rotator repair after total hip replacement[J]. Clin Orthop Relat Res, 2004(420):199-204. DOI: 10.1097/00003086-200403000-00028
[20]
Parcells BW, Macknet DM, Kayiaros ST.The direct anterior approach for 1-stage bilateral total hip arthroplasty: early outcome analysis of a single-surgeon case series[J]. J Arthroplasty, 2016,31(2):434-437. DOI: 10.1016/j.arth.2015.08.040
[21]
Schmidt-Braekling T, Waldstein W, Akalin E, et al.Minimal invasive posterior total hip arthroplasty: are 6 weeks of hip precautions really necessary?[J]. Arch Orthop Trauma Surg, 2015,135(2):271-274. DOI: 10.1007/s00402-014-2146-x
[22]
Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures[J]. Bone Joint J, 2013,95-B(8):1134-1138. DOI: 10.1302/0301-620X.95B8.31495
[23]
Connolly KP, Kamath AF.Direct anterior total hip arthroplasty: literature review of variations in surgical technique[J]. World J Orthop, 2016,7(1):38-43. DOI: 10.5312/wjo.v7.i1.38
[24]
De Geest T, Fennema P, Lenaerts G, et al.Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis[J]. Arch Orthop Trauma Surg, 2015,135(8):1183-1192. DOI: 10.1007/s00402-015-2258-y
[25]
李骏然, 翟婧秀, 赵洪波, 等. 牵引床直接前侧入路人工全髋关节置换术的学习曲线分析[J].中国微创外科杂志,2021,21(11):1024-1030. DOI: 10.3969/j.issn.1009-6604.2021.11.014Li JR, Zhai JX, Zhao HB, et al.Learning curve analysis of total hip arthroplasty through the direct anterior approach with the use of a traction table[J]. Chin J Microsurg, 2021,21(11):1024-1030. DOI: 10.3969/j.issn.1009-6604.2021.11.014
[26]
Kawaguchi AL, Kao LS.Teamwork and surgical team-based training[J]. Surg Clin North Am, 2021,101(1):15-27. DOI: 10.1016/j.suc.2020.09.001.
2022, Vol. 27 
