髋关节置换术后B2型股骨假体周围骨折的个体化治疗  

Individualized treatment for Vancouver B2 periprosthetic femoral fracture after hip arthroplasty

作　　者：许福生[1] 柯荣军[1] 顾永福[1] 刘方刚[1] 祁伟[1] 

机构地区：[1]中国人民解放军第359医院关节外科,江苏镇江212000

出　　处：《中华关节外科杂志（电子版）》2016年第5期82-86,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨髋关节置换术后Vancouver B2型股骨假体周围骨折的个体化治疗。方法2010年5月至2014年8月,解放军第359医院关节外科共收治了21例髋关节置换术后B2型股骨假体周围骨折,根据美国麻醉医师协会评分（ASA）的分级选择治疗方案,第5级行非手术治疗（5例）,第4级行内固定术（6例）,第1、2、3级行髋关节翻修术（10例）。采用Harris髋关节功能评分（HHS）中的疼痛、功能评分对患者伤前及术后随访1年进行统计学分析,记录两种不同手术方法的手术时间、术中出血量并进行统计学分析,影像学评估包括骨不连及假体稳定性,记录相关并发症。结果对本组患者随访1~5年,骨折术前、术后随访1年时疼痛评分分别为（32.8±2.8）分、（25.9±2.7）分,术后的疼痛评分比术前降低,两组间差异有统计学意义（t=4.3,P〈0.05）;骨折前及术后随访1年时功能评分分别为（24.4±2.2）分、（16.0±2.2）分,两组间差异有统计学意义（t=6.0,P〈0.05）。切开复位内固定术与翻修术,平均手术时间分别为（76.3±4.3）min、（148.7±4.6）min,两组间差异有统计学意义（t=3.2,P〈0.05）;平均出血量分别为（186.5±6.3）ml、（1548.3±2.8）ml,两组间差异有统计学意义（t=4.6,P〈0.05）。骨折平均愈合时间（3.6±1.6）个月（3~6个月）。2例发生骨不连,1例发生切口浅部感染,4例发生深静脉血栓形成,2例非手术治疗患者死亡。无骨折畸形愈合、植入物失败、脱位、假体松动等情况。结论治疗Vancouver B2型股骨假体周围骨折,除参照Vancouver治疗原则外,还应取决于患者伤前的步态、身体状况。Objective To discuss the individualized treatment for Vancouver B2 periprosthetic femoral fracture after hip arthroplasty. Methods From May 2010 to August 2014, 21 cases with periprosthetic femoral fractures after hip arthroplasty were retrospectively reviewed. Treatment programs were determined by the American Society of Anesthesiologists （ASA） classification： the 5th grade accepted conservative treatment （five cases） ; the 4th grade accepted osteosynthesis （six cases） ; the 1st grade, the 2nd grade and the 3rd grade accepted revision arthroplasty （10 cases）. Pain score and ambulatory score （part of Harris hip score） were assessed before the fracture and in the first year follow-up. Radiological results including bony union and stem stability were also evaluated. Operation time ane intraoperative bleeding were assessed in the surgically treated patients. Complications was assessed in all the patients. Results All the patients were available for an average duration of follow-up of （2. 8 ± 2. 3 ） years （ 1 - 5 years）. Pain score before the fracture and at the first year follow-up was （32. 8 ±2. 8） and （25.9 ±2. 7） （ t = 4. 3, P 〈 0. 05） ; ambulatory score was （24. 4 ± 2. 2） and （ 16.0 ± 2. 2） （ t = 6. 0, P 〈 0. 05）. The mean operation time was （76. 3 ＋4. 3） minutes of the osteosynthesis cases and （148. 7±4. 6） minutes of the revision arthroplasty eases （ t = 3.2, P 〈 0. 05）. The mean intraoperative bleeding volume was （ 186. 5 ± 6. 3 ） ml of the osteosynthesis cases and （1548.3± 2. 8 ） ml of the revision arthroplasty cases （t = 4.6, P 〈 0. 05）. Bone healed in average （3.6 ± 1.6） months （3 - 6 months）. Bone un-union was observed in two cases, superficial infection in one case, DVT in four eases. The two cases of conservative treatment resulted in death. No sign of malunion, implant failure, dislocation and loosening of the prosthesis was observed. Conclusion The decision regarding treatment methods for periprost

关 键 词：关节成形术 置换 髋 假体周围骨折 再手术 

分 类 号：R687[医药卫生—骨科学]