有限切开双钢板固定治疗人工髋关节置换术后股骨假体周围Vancouver B1型骨折  

LIMITED OPEN REDUCTION AND DOUBLE PLATES INTERNAL FIXATION FOR TREATMENT OF Vancouver TYPE B1 PERIPROSTHETIC FEMORAL FRACTURE AFTER HIP ARTHROPLASTY

作　　者：张岩[1] 范鑫斌[1] 刘粤[1] 邵进[1] 唐江安[1] 刘树义[1] 杨铁毅[1] 张长青[2] 

机构地区：[1]上海市浦东新区公利医院骨科,上海200135 [2]上海交通大学附属第六人民医院骨科

出　　处：《中国修复重建外科杂志》2013年第12期1428-1431,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市浦东新区卫生系统学科带头人资助项目(PWRd2012-16);上海市浦东新区科技发展基金创新资金项目(PKJ2011-Y09);上海市浦东新区卫生局重点学科资助项目(PWZxk2010-08)~~

摘　　要：目的探讨有限切开双钢板固定治疗人工髋关节置换术后股骨假体周围VancouverB1型骨折的疗效。方法回顾分析2007年5月-2012年10月，采用有限切开双钢板固定治疗的12例人工髋关节置换术后股骨假体周围VancouverB1型骨折患者临床资料。男4例，女8例；年龄76～85岁，平均81．6岁。左髋5例，右髋7例。双动头髋关节置换4例，全髋关节置换8例；骨水泥型股骨假体3例，生物型股骨假体9例。关节置换术后5个月～5年发生骨折，中位时间13个月。致伤原因：交通事故伤2例，摔伤10例。合并对侧胫、腓骨及同侧肱骨远端骨折1例，同侧肱骨近端骨折2例，同侧桡骨远端骨折1例，肋骨骨折1例。受伤至手术时间3～10d，平均5．6d。结果术后切口均I期愈合，无感染及下肢深静脉血栓形成等并发症发生。12例均获随访，随访时间6～24个月，平均13_3个月。其中1例女性患者随访16个月时，因大面积心肌梗死死亡。x线片检查示骨折愈合时间10～16周，平均12．5周。患者完全负重时间为10～18周，平均13周。10例患者能自由行走，2例在助行器辅助下行走。末次随访时，髋关节Harris评分为75～93分，平均87．3分。结论对于人工髋关节置换术后股骨假体周围VancouverB1型骨折，采用有限切开双钢板固定可维持骨折稳定性，保护血运，促进骨折愈合，允许早期功能锻炼，获得较好近期疗效，远期疗效有待进一步观察。Objective To evaluate the effectiveness of limited open reduction and double plates internal fLxation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years （mean, 81.6 years）; the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months （range, 5 months-5 years）. The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture （1 case）, ipsilateral proximal humeral fracture （2 cases）, ipsilateral distal radial fracture （1 case）, and rib fracture （1 case）. The time from injury to operation was 5.6 days on average （range, 3-10 days）. Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months （mean, 13.3 months）. One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average （range, 10-16 weeks）. The time of full weight bearing was 13 weeks on average （range, 10-18 weeks）. Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hi p function was 87.3 on average （range, 75-93）. Conclusion The method of limited open reduction and dou

关 键 词：人工髋关节置换 股骨假体周围骨折 双钢板固定 

分 类 号：R687.4[医药卫生—骨科学]