全髋关节置换术中髋臼假体周围骨折的危险因素分析及处理  

Risk factors and treatment of intraoperative periprosthetic acetabular fracture during total hip arthroplasty

作　　者：程琪 郭开今 赵凤朝 郑欣 庞勇 王一 唐金龙 顾江江 Cheng Qi;L Guo Kaijin;Zhao Fengchao;Zheng Xin;Pang Yong;Wang Yi;Tang Jinlong;Gu Jiangjiang(Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China)

机构地区：[1]徐州医科大学附属医院骨科,221002

出　　处：《中华骨科杂志》2018年第11期641-649,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81672184）;江苏省六大人才高峰C类项目（2015-WSN-065）;江苏省科教强卫工程青年医学人才项目（2016QNRC801）;江苏省科技厅社会发展重点项目（BE2015627,BE2016642）;中国博士后科学基金面上项目（2016M591929）

摘　　要：目的探讨全髋关节置换术中髋臼假体周围骨折的危险因素、骨折特点及处理方法。方法回顾性分析2012年1月至2015年6月接受全髋关节置换术的患者1023例（1168髋），男421例（507髋），女602例（661髋）；年龄23～96岁，平均（64．2±15．0）岁。初次全髋关节置换1053髋，全髋关节翻修115髋。对初次置换术中发生髋臼假体周围骨折患者的年龄、性别、体重指数、侧别、原发疾病、手术人路、髋臼骨质疏松、假体类型、假体骨性覆盖率等相关因素行单因素及Logistic回归分析，筛选初次全髋关节置换术中髋臼假体周围骨折的独立危险因素。通过卡方检验分析初次置换和翻修术中髋臼假体周围骨折发生率的差异。结果髋关节置换术中髋臼假体周围骨折的总体发生率为2．8％（33／1168）。翻修术中髋臼假体周围骨折发生率为6．1％（7／115），高于初次置换术的2．5％（26／1053），差异有统计学意义（χ2=4．943，P=0．026）。多因素Logistic回归分析中，原发疾病（发育性髋关节发育不良或类风湿关节炎）、骨质疏松、生物型髋臼杯、假体骨性覆盖率高、医生年手术量少是初次全髋关节置换术中髋臼假体周围骨折发生的危险因素。髋臼假体周围骨折33髋中，于术中发现13髋（39．4％，13／33）；术后发现20髋（60．6％，20／33），髋臼壁骨折26髋（78．8％，26／33）、髋臼柱骨折2髋（6．1％，2／33）、髋臼方形区骨折伴假体中心性脱位3髋（9．1％，3／33）、髋臼横形骨折2髋（6．1％，2／33）。假体稳定性骨折26髋（78．8％，26／33），术中检出率26．9％（7／26）；非稳定性骨折7髋（21．2％，7／33），术中检出率85．7％（6／7）。髋臼壁骨折采用螺钉加强固定或保守治疗，髋臼柱骨折采用钢板固定，髋臼方形区骨折伴假体中心性脱位采用Jumbo杯翻修1髋、金属重建杯2Objective To analyze the risk factors of periprosthetic acetabular fracture in total hip arthroplasty （THA） and to discuss the prevention and management. Methods A total of I 023 patients （1 168 hips） undergoing THA were retrospectively analyzed between January 2012 and June 2015. There were 421 males （507 hips） and 602 females （661 hips）, aged from 23 to 96 years with mean age of 64.2±15.0 years. Primary total hip arthroplasty was conducted in 1 053 hips, while revision surgery was conducted in 115 hips. The reasons of periprosthetic acetabular fracture were summarized. Age, gender, BMI, primary disease, left or right sides, surgical approach, osteoporosis, prosthetic type, the coverage rate of acetabulum-bone, and the amount of surgical operation annually were compared between non-fracture and fracture. Risk factors associated with the fracture were analyzed using chi square test followed by a multivariate logistic regression. Furthermore, revision surgery was compared with primary THA using chi square test. Results The incidence of intraoperative periprosthetic acetabular fractures was 2.8% （33/1 168）. The incidenceof fracture was higher in revision surgery than that in primary THA （6.1% vs. 2.5%）. Multivariate logistic regression showed that primary disease （developmental dysplasia of the hip and rheumatoid arthritis）, osteoporosis, uncemented acetabular cup, the high- er coverage rate of acetabulum-bone, and the less amount of surgical operation annually were prone to appear periprosthetic ace- tabular fracture in primary THA. Among the 33 patients with acetabular fractures, 13 cases （39.4%, 13/33） were found intraopera- tively and 20 cases （60.6%, 20/33） postoperatively. Acetabular wall fractures were in 26 （78.8%, 26/33）, column fractures in 2 （6.1%, 2/33）, transverse fractures in 2 （6.1%, 2/33） and quadrilateral surface fractures with prosthetic central dislocation in 3 （9.1%, 3/33）. Seven cases of 26 stable fractures and 6 cases of 7 unstable fractures

关 键 词：关节成形术 置换 髋 髋臼 骨折 危险因素 

分 类 号：R687.4[医药卫生—骨科学]