机构地区:[1]北京大学人民医院骨关节科(北京大学人民医院关节病诊疗研究中心、北京大学关节病研究所),100044
出 处:《中华骨科杂志》2017年第15期906-913,共8页Chinese Journal of Orthopaedics
基 金:国家重点研发计划(2016YFC1101805)
摘 要:目的探讨人工髋关节置换术后股骨假体周围骨折的手术方法及临床疗效。方法凹顾性分析2009年9月至2016年5月采用手术治疗的12例股骨假体周围骨折患者,男6例,女6例;年龄35—86岁,平均(66.4±15.0)岁。初次髋关节置换术后9例,髋关节翻修术后3例;股骨假体11例为生物型,1例为骨水泥型。Vancouver分型B1型2例,B2型7例,B3型1例,C型2例。骨折发生时间为术后3周至17年,平均(9.0±7.0)年。依据Vancouver分型采用不同的治疗方法:B1型骨折复位后采用以捆绑带为主的方式进行固定;B2型取出原股骨柄假体,采用翻修加长柄辅以捆绑带的方式进行固定;B3型取出原股骨柄假体,采用翻修加长柄和捆绑带固定,骨质缺损处以异体骨板加固;c型骨折复位后采用股骨远端钢板和锁定螺钉固定。随访时记录Harris髋关节评分及骨折部位疼痛视觉模拟评分(visual analogue scale,VAS),通过骨折部位的疼痛情况及x线片来判断骨折是否愈合。结果全部病例均获得随访,随访时间12—92个月,平均(41.6±26.0)个月。11例患者骨折部位负重VAS评分为0分,达到临床愈合;1例患者术后发生感染,多次行清创术,骨折部位负重VAS评分6分,骨折未愈合。骨折临床愈合率91.7%(11/12)。末次随访时Harris髋关节评分23~92分,平均(74.8±18.8)分;其中优2例、良6例、中3例、差1例,优良率66.7%(8/12)。术后出现并发症4例(33.3%,4/12):1例引流管被缝,再次行探企术拔除;1例发生关节周围感染,反复清创,导致骨折不愈合;2例股骨柄假体松动,再次行翻修术。结论髋关节置换术后股骨柄假体周嗣骨折手术治疗并发症发生率较高。根据股骨假体周围骨折vancouver分型选择个性化治疗方案,骨折临床愈合率91.7%,术后早中期髋关节功能优良率66.7%。Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty. Methods Twelve consecutive patients (6 male and 6 female) with the average age of 55.4± 15.0 years old (35 to 85 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center. Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery. The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation. The enrolled patients were determined as Vancouver type B1 (n=2), type B2 (n=7), type B3 (n=1) and type C (n= 2) respectively. The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years). The patients were treated individually according to different Vancouver types. Type B1 patients received simple cerclage fixation, as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients. In addition to the treatment for type B2 patients, allogenic cortical bone graft was also required for type B3 patients. Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures. The following-up included the X-ray images of the hips, Harris hip score and the visual analogue scale (VAS) for the pain of fracture site. The unions of the fractures were determined by both X- ray images and pain intensity of the fracture sites. Results The mean follow-up period was 41.6±26.0 months (range, 12-92 months), without patient lost to follow up. VAS scores were 0, implying the clinical union of the fractures. One patients receivedmultiple debridement post-operatively due to the periprosthetic infection. The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture. The fracture union rate was
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