不同手术入路的双钢板技术在全膝关节置换术后股骨假体周围骨折中的应用  

Double plating through different approaches for periprosthetic femoral fracture following total knee arthroplasty

作　　者：张占丰[1] 邢时通[1] 严世贵[2] 吴立东[2] 吴浩波[2] 施利华[1] ZHANG Zhan-feng;XING Shi-tong;YAN Shi-gui;WU Li-dong;WU Hao-bo;SHI Li-hua(Department of Orthopaedics,the First People’s Hospital of Huzhou,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院骨科,浙江湖州313000 [2]浙江大学医学院附属第二医院骨科,浙江杭州310051

出　　处：《中国骨伤》2019年第8期686-691,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨采用不同手术入路的股骨远端双钢板技术治疗粉碎性、骨质疏松明显的全膝关节置换术后股骨假体周围骨折的临床疗效。方法:自2010年7月至2017年6月,将收治的全膝关节置换术后股骨侧假体周围骨折患者21例根据不同手术入路分为2组。内外侧双入路组(双入路组)15例,男5例,女10例;年龄63~79(67.2±5.9)岁;骨折根据AO-OTA分型,33-A2型11例,33-A3型4例;摔伤12例,交通伤3例;采用双钢板技术固定治疗。髌旁内侧入路组(单入路组)6例,男3例,女3例;年龄61~74(64.6±6.0)岁;骨折按照AO-OTA分型,33-A2型3例,33-A3型3例;摔伤5例,交通伤1例;采用双钢板技术固定。比较两组患者的手术时间、术中出血量、术后引流量、骨折愈合时间,并于术后3、12个月比较两组膝关节HSS评分和影像学表现。结果:所有患者获得随访,双入路组随访时间12~18(14.2±2.6)个月,单入路组随访时间12~16(12.6±2.5)个月;两组比较差异无统计学意义。双入路组手术时间、术后引流量分别为(107.2±10.4)min、(213.9±30.4)ml,单入路组手术时间、术后引流量分别为(95.4±12.8)min、(256.8±34.2)ml,两组比较差异有统计学意义(P<0.05);两组患者术中出血量、骨折愈合时间比较差异无统计学意义(P>0.05)。术后3、12个月时双入路组HSS评分分别为82.9±5.7、84.8±7.1,单入路组HSS分别为83.6±6.1、86.3±6.8,两组比较差异无统计学意义(P>0.05)。术后12个月根据HSS评分,双入路组优2例,良13例;单入路组优1例,良4例,中1例;两组比较差异无统计学意义(χ^2=2.625,P=0.105)。术后12个月随访时,双入路组2例出现并发症,单入路组1例出现并发症,两组比较差异无统计学意义(P>0.05)。结论:对于粉碎性、骨质疏松明显的全膝关节置换术后股骨侧假体周围骨折,采用双钢板技术固定能获得较好的膝关节功能,髌旁内侧入路手术时间更短,内外侧双入路术后引流量更少。Objective:To study clinical effects of double plating through different approaches for communicated and obvious osteoporosis periprosthetic femoral fracture following total knee arthroplasty(TKA).Methods:From July 2010 to June 2017,21 patients with periprosthetic femoral fracture following TKA were divided into two groups according to operative approach.Fifteen patients in medial and lateral double approaches group,including 5 males and 10 females aged from 63 to 79 years old with an average of(67.2±5.9)years old;11 patients were type 33-A2 and 4 patients were type 33-A3 according to AO-OTA classification;12 patients injured by falling down and 3 patients by traffic accident;treated with double plating.Six patients in medial parapatellar approach group,including 3 males and 3 females,aged from 61 to 74 years old with an average of(64.6±6.0)years old;3 patients were type 33-A2 and 3 patients were type 33-A3 according to AO-OTA classification;5 patients injured by falling down and 1 patient by traffic accident;treated with double plating.Operative time,blood loss,postoperative drainage,fracture healing time were compared between two groups;HSS score and radiology at 3 and 12 months were compared between two groups.Results:All patients were followed up,and the follow-up time of bilateral approaches group ranged from 12 to 18 months with an average of(14.2±2.6)months,while the follow-up time of single approach group ranged from 12 to 16 months with an average of(12.6±2.5)months,and there was no statistical difference between two groups.The operative time and postoperative drainage in bilateral approaches group were(107.2±10.4)min and(213.9±30.4)ml,while in sigle approach group was(95.4±12.8)min and(256.8±34.2)ml,and the differences were significant(P<0.05).There were no significant difference in blood loss and fracture healing time(P>0.05). HHS score at 3 and 12 months after operation in bilateral approach were 82.9±5.7 and 84.8±7.1,while in single approach group were 83.6±6.1 and 86.3±6.8;there was no st

关 键 词：关节成形术 置换 膝 股骨 假体周围骨折 

分 类 号：R683[医药卫生—骨科学]