人工髋关节置换术后股骨假体周围骨折的分类方法及治疗  

Study on the classification of femoral fractures surrounding prosthesis after total hip replacement

作　　者：唐江安[1] 杨铁毅[1] 王思辉[1] 王治[1] 应辉[1] 

机构地区：[1]第二军医大学附属上海浦东新区公利医院骨科,上海200135

出　　处：《临床和实验医学杂志》2016年第20期2032-2034,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的分析人工髋关节置换术后股骨假体周围骨折分类方法和治疗手段。方法收集人工髋关节置换术后股骨假体周围骨折(PFF)25例,采用改良Vancouver分类法对PFF进行分类,根据分类采用内固定、异体植骨术等手术治疗或采用非手术方法治疗,评估疗效,记录骨折愈合时间及并发症发生情况。结果本组患者改良Vancouver分类法分类结果:TG型2例,A2型2例,B1型5例,B2型10例,B3型2例,C型4例。治疗方法:TG型非手术,A2、B1型内固定;B2型内固定加翻修,B3型内固定和翻修和植骨,C型内固定。骨折平均愈合时间为(4.75±1.48)月,平均Harris分值为86.23±11.20;影像学评估疗效优良率为80.00%,整体疗效评估优良率为84.00%。1例切口感染,1例钢板远端股骨再骨折,均得到有效治疗,并发症发生率为8.00%。结论改良Vancouver分类法对PFF治疗有重要指导意义,根据不同类型采取内固定、异体植骨术、翻修等方法治疗,能取得良好疗效,并发症少。Objective To analyze the method for classification and treatment of femoral fractures around prosthesis after hip replacement.Methods A total of 25 patients with femoral fractures around the prothesis after artificial replacement were collected for this study,the application of improved Vancouver classification for PFF,classification based on the classification,internal fixation,allogeneic bone grafting and other surgical or non-surgical treatment method had been applied to assess the efficacy of fracture,and the healing time and occurrence of complications were observed.Results The results of classification with modified Vancouver classification were as follows：2 cases belonged to TG type,2 cases as type A2,5 cases as type B1,10 cases as type B2,2 cases as type B3,and 4 cases in type C 4.The methods for treatment as follows：TG type with non-surgical treatment,A2 and B1 types with internal fixation;B2 type with internal fixation and revision,type B3 with internal fixation,revision and bone graft,and C type with internal fixation.The mean healing time of patients was（ 4.75 ± 1.48） months,the average Harris scores were 86.23 ± 11.20;excellent rate of imaging for assessment of the efficacy was 80.00%,the good overall assessment for the efficacy was84.00%.One case got wound infection,one case suffered with re-fracture of femur at distal side of steel plate,and they were effectively treated,and the rate of complications was 8.00%.Conclusion The modified Vancouver classification for treatment of PFF has important guiding significance.The treatment with different types of fixation,allogeneic bone grafting and other renovations can achieve good efficacy with less complications.

关 键 词：人工髋关节置换 股骨假体周围骨折 改良Vancouver分类 治疗 

分 类 号：R687.3[医药卫生—骨科学]