手术治疗全髋关节置换术B1型股骨假体周围骨折后Vancouver  

Surgical treatments for Vancouver type B1 periprosthetic femoral fractures

作　　者：廖乐明 蔡迅梓[1] 吴浩波[1] 严世贵[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2017年第15期936-941,共6页Chinese Journal of Orthopaedics

基　　金：国家临床重点专科项目.

摘　　要：目的探讨全髋关节置换术后VancoaverB1型股骨假体周用骨折的治疗结果。方法回顾性分析2006年12月至2016年6月收治的VanccouverB1型股骨假体周围骨折患者17例，男5例，女12例；年龄37-86岁，平均70．4岁。骨折发生于初次关节置换术后1-288个月，平均65．1个月。12例采用切开复位钢板内固定；5例原发性骨量减少、髋臼内衬磨损、假体柄使用时间较长者（预计假体寿命偏短）行全髋关节或股骨侧翻修及钢丝或钛缆捆扎固定，翻修似体为Solution假体1例、Wagner假体2例、Echelon假体1例、Secur—Fit Max假体1例。术后1、3、6、12个月及之后每年随访1次，记录Harris髋关节功能评分，评估X线骨折愈合、假体稳定性及并发症的发生率。结果全部病例均获得随访，随访时间7-120个月，平均56个月。内固定组术中失血量为（385±129）ml，翻修组（531±113）ml。内固定组手术时间（72±36）min，翻修组（126±48）min。术后3个月翻修组病例骨折均愈合，内固定组有1例未愈合。内固定组Harris髋关节评分（68．8±18．4）分、翻修组（75．0±8．9）分，与术前（46．2±9．6）分和（57．4±13．0）分比较差异均有统计学意义。内固定组发生骨折延迟愈合1例、术后长期疼痛1例、术后再骨折1例，并发症发生率25％（3／12）；翻修组1例术中失血过多、1例术后长期疼痛。结论对个髋关节置换术后VancouverB1型股骨假体周围骨折应常规选择切开复位内固定术。当患者存在原发性骨量下降、髋臼内衬磨损、假体柄使用时间较长（预计假体寿命偏短）时可采用髋关节翻修。Objective To investigate the outcomes of the treatments for the patients with Vancouver type B 1 periprosthet- ic femur fractures. Methods Seventeen patients with periprosthetie femoral fractures （5 males and 12 females; average age, 70.4 years, range from 37 to 86 years） who underwent revision arthroplasty or open reduction and internal fixation between December 2006 and June 2016 were retrospectively reviewed. Periprosthetic femoral fractures occurred at the mean time of 65. 1 months after arthroplasty. Twelve patients underwent open redaction and internal fixation and five cases underwent total hip or stem revision with Solution from Depuy, Wagner from Zimmer, Echelon from Smith ＆ Nephew or Seeur-Fit Max from Stryker due to primary bone loss, acetabular component wear or long-time prosthesis use respectively. Data were collected at 1, 3, 6 aud 12 months and then each year postoperatively. All patients were followed up, and the results of X-ray, postoperative Harris hip score, stability of prosthesis and complications were also evaluated. Results A total of 5 patients underwent revision arthraplasty, and 12 patients underwent open reduction and internal fixation. The mean follow-up duration was 56 months （range from 7 to 120 months）. Total blood loss in the open reduction and internal fixation group and in revision group was 385± 129 ml and 531 ± 113 ml respectively. The operation duration in the open reduction and internal fixation group was 72±36 min while it was 126±48 rain in the revision group. The postoperative Harris hip score in the open reduction and internal fixation group was significantly increased compared with preoperative Harris hip score （68.8±18.4 vs. 46.2±9.6）, as well as in the revision graup （75.0±8.9 vs. 57.4± 13.0）. For the inci- dence of complications, in the open reduction and internal fixation group, one patient suffer with delayed fracture union, one pa- tient complained about persistent pain and one suffered a secondary fracture, while in the revision group o

关 键 词：关节成形术 置换  髋 假体周围骨折 股骨骨折 再手术 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]