初次全髋关节置换术中Corail柄假体周围骨折原因与防治  

Risk factors and prevention of periprosthetic femoral fractures around the Corail stem during primary total hip arthroplasty

作　　者：张启栋[1] 郭万首[1] 岳德波[1] 史振才[1] 张念非[1] 孙伟[1] 刘朝晖[1] 王卫国[1] 

机构地区：[1]中日友好医院骨关节外科,北京100029

出　　处：《中华创伤杂志》2017年第1期69-74,共6页Chinese Journal of Trauma

摘　　要：目的探讨在初次全髋关节置换术（THA）术中发生Corail柄假体周围骨折的原因及防治措施。方法采用回顾性队列研究分析2010年1月-2016年3月初次THA术中Corail柄假体周围骨折18例（18髋）患者，其中男7髋，女11髋；年龄42～81岁，平均57．6岁。原发疾病：炎性关节病6髋，股骨头缺血性坏死5髋，髋关节发育不良4髋，股骨颈骨折3髋。患者局部存在问题14髋（78％），其中合并骨质疏松11髋（61％）。术中发现股骨假体周围骨折15髋并采用双股钢丝环扎；术后X线发现术中隐匿性骨折3髋，其中1髋非手术治疗，另外2髋再次手术，1髋采用双股钢丝环扎固定，1髋切开复位钢板联合钢缆内固定。对术中出现骨折的原因进行分析。采用Harris评分评估临床疗效，Beals和Tower评分标准行影像学评估。结果骨质疏松（P〈0．01）、炎性关节病（P〈0．01）、股骨近端解剖结构异常（P〈0．01）、手术技术或操作不当（如术中过分追求假体与皮质紧密压配、假体型号选择不当、手术暴力等）（P〈0．01）是造成初次THA术中Corail柄假体发生股骨假体周围骨折的主要原因。患者均获随访平均32个月。骨折均获得愈合，平均愈合时间为4．7个月。元假体松动及感染。末次随访时Harris评分91．2分。Beals和Tower评分标准：优16髋，良2髋。结论严格选择患者，把握手术技术是预防的关键。一旦发生股骨假体周围骨折，稳定型骨折行钢丝环扎术即可达到稳定假体和骨折的目的，操作简单且临床效果满意。Objective To investigate the causes and prevention of intraoperative periprosthetic femoral fractures around the Corail stem associated with primary total hip arthroplasty （THA）. Methods A retrospective cohort study was made on 18 patients （ 18 hips） developing intraoperative periprosthetic femoral fractures around the Corail stem during primary THA between January 2010 and March 2016. There were 7 male and 11 female patients, with the age range of 42-81 years （ mean, 57.6 years）. At the time of diagnosis, six hips presented with inflammatory arthropathy, five avascular necrosis of the femoral head, four developmental dysplasia of hip, and three femoral neck fractures. Local problems were identified in 14 hips （ 77.8% ）, principally osteoporosis in 11 hips （ 61% ）. Fifteen periprosthetic femoral fractures were recognized intraoperatively and were treated with cerclage wires. Three intraoperatively occult fractures were observed on the postoperative radiograph, including one fracture treated non-operatively, one by wire cerclage fixation and one by open reduction internal fixation.Factors related to intraoperative fractures were analyzed. Harris score and Beals and Tower＇s criteria were used for clinical and radiological assessment respectively, Results Osteoporosis, inflammatory arthropathy, anatomical abnormity of the proximal femur, excessive pursuit of the degree of interference fit between prosthesis and cortical bone, and inappropriate choice of prosthesis size were the main causes of femur fractures during primary THA. Mean follow-up was 32 months. Union was obtained in all patients in a mean of 4. 7 months. No prosthesis loosening and infection occurred. Mean Harris hip score was 91.2 points at the final follow-up. Radiological assessment showed excellent results in 16 hips and good results in two hips. Conclusions Rigidity in patient selection and master of surgery techniques are the key to preventing periprosthetic femoral fractures. Once the periprosthetic femoral fractures happens

关 键 词：关节成形术 置换 髋 假体周围骨折 危险因素 

分 类 号：R687.3[医药卫生—骨科学]