Abstract：Objective To explore the causes of failure of internal fixation of hip fracture and analyze the effect of hip replacement.Methods From March 2011 to July 2018, the clinical data of 45 patients with failed internal fixation of hip fracture in the First Affiliated Hospital of Harbin Medical University were collected, including 16 males and 29 females, with an average age of 47.5 years (35-80 years). There were 33 femoral neck fractures and 12 intertrochanteric femoral fractures. According to Garden classification, femoral neck fractures were divided into type Ⅱ of 6 cases, type Ⅲ of 20 cases, and type Ⅳ of 7 cases; according to modified Evans classification, intertrochanteric femoral fractures were divided into type Ⅲ of 1 case, type Ⅳ of 4 cases, and type V of 7 cases. The causes of failure were analyzed and summarized. Total hip arthroplasty was performed in 35 cases and hemiarthroplasty in 10 cases. The operation time, intraoperative blood loss and postoperative complications were observed. Harris hip score was used to compare the improvement of hip joint function before and after operation.Results All patients were successfully operated. The operation time was 50 to 150 minutes (average 72 minutes). Intraoperative blood loss was 150 to 600 mL (average 260 mL). One intraoperative periprosthetic fracture was fixed with steel wire. Postoperatively, 5 cases of deep vein thrombosis and 4 cases of superficial infection were healed after treatment, 2 cases of length discrepancy (more than 2 cm) were found and without special treatment. Forty-five patients were followed up for 5-30 months (average 10.5 months). There were no complications such as infection, periprosthetic fracture, joint dislocation and prosthesis loosening. The periprosthetic fracture healed 3 months after operation. Compared with preoperatively, Harris score was significantly improved, which was 82-94 (88±6) vs 32-36 (34±2) . The difference was statistically significant(t=49.258, P＜0.01). In the last follow-up, Harris score was excellent in 16 cases, good in 24 cases, fair in 4 cases and poor in 1 case, with an excellent and good rate of 88.9%(40/45). The cause for the failure were analyzed as: 27 cases were caused by the poor operative technique, including 12 cases with unsatisfactory screw position or length, 8 cases with improper selection of fixation, 10 cases with poor reduction; 18 cases of femoral neck fracture were treated longer than 72 hours after injury, within 9 cases longer than 1 week; 15 cases with excessive early weight-bearing time (less than 12 weeks); postoperative re-hurted in 6 cases and 7 cases without any obvious inducement.Conclusions The causes of failure of internal fixation of hip fracture include iatrogenic factors and patient factors. According to the age and general condition of patients, total hip arthroplasty or hemiarthroplasty is an effective option for treatment.
刘宁, 孙浩远, 宋科官. 髋部骨折内固定术失败后行人工髋关节置换术的临床分析[J]. 中华解剖与临床杂志, 2020, 25(1): 61-66.
Liu Ning, Sun Haoyuan, Song Keguan. Clinical analysis of hip arthroplasty after failure of internal fixation for hip fracture. Chinese Journal of Anatomy and Clinics, 2020, 25(1): 61-66.
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2020, Vol. 25 
