JOURNAL ARTICLE

[Clinical analyses of total hip replacement for treatment of ischemic necrosis of femoral head combined with intertrochanteric fracture]

Yongqiang Sun, Shangzeng Wang
Chinese Journal of Reparative and Reconstructive Surgery 2008, 22 (7): 773-5
18681271

OBJECTIVE: To explore the way and therapeutic effect of one stage total hip replacement (THR) in treating ischemic necrosis of femoral head combined with intertrochanteric fracture.

METHODS: From July 1997 to September 2005, one stage THR was performed in 18 cases (11 left and 7 right) of ischemic necrosis of femoral head combined with fresh intertrochanteric fracture, including 13 males and 5 females, with an age range of 32-60 years. There were 11 primary cases, 2 cases of ankylosing spondylitis, 2 cases of rheumatic arthritis, 2 cases of congenital acetabular dysplasia and 1 case of femoral neck fracture fixed using cannulated cancellous screws postoperatively in all cases of ischemic necrosis of femoral head. They suffered from ischemic necrosis of femoral head for 8 years (4-23 years). According to Evan's intertrochanteric fracture classification, there were 4 cases of type II, 6 cases of type III, 5 cases of type IV and 3 cases of type V. According to the Ficat ischemic necrosis of femoral head classification, there were 5 cases of type III, and 13 cases of type IV. The disease course was 2-12 hours. The average value of Harris evaluation was 35.2 preoperatively. The prosthesis of biology was used.

RESULTS: All wounds healed by first intention. One case suffered deep venous thrombosis 3 days postoperatively and recovered completely after treatment. No infection of urinary system and lung as well as no bedsore occurred postoperatively. The X-ray films showed that the fracture ends healed and that prosthesis had good form attitude and position after 4 months of operation. All cases were followed up for 2 years. They could walk and take care of themselves after 6 months. The average value of Harris evaluation was 94.7 points postoperatively (P < 0.05). The results were excellent in 15 cases, good in 2 cases, fair in 1 case according to Harris evaluation standard of THR; the excellent and good rate was 94.4%.

CONCLUSION: One stage THR for treating ischemic necrosis of femoral head combined with intertrochanteric fracture can avoid secondary operation. It could resume the ideal function of the hip joint.

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