新型股骨锁定钢板联合钛缆内固定治疗Vancouver B1型股骨假体周围骨折的疗效分析  

Clinical efficacy of a new femoral locking plate combined with titanium cables internal fixation in treatment of Vancouver B1 periprosthetic femoral fractures

作　　者：荚龙 吴晓天 周凯华 何小健 陈铭吉 高如峰 JIA Long;WU Xiaotian;ZHOU Kaihua;HE Xiaojian;CHEN Mingji;GAO Rufeng(Department of Orthopaedics,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201799,China)

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《中国骨与关节损伤杂志》2024年第8期790-793,共4页Chinese Journal of Bone and Joint Injury

基　　金：复旦大学附属中山医院青浦分院科研课题(QYM2022-07);蚌埠医科大学自然科学类项目(2023byzd199)。

摘　　要：目的观察新型股骨锁定钢板联合钛缆捆扎内固定治疗Vancouver B1型股骨假体周围骨折的临床疗效。方法本研究回顾性分析自2019-06—2022-06于笔者所在医院采用带有大粗隆钩形爪结构的新型股骨钢板联合钛缆捆扎内固定治疗10例Vancouver B1型股骨假体周围骨折。骨折复位后选择合适长度带有大粗隆钩形结构的股骨锁定钢板置于股骨外侧,近端钩形装置钩住大粗隆,采用专用的弧形导向器于大粗隆下方用1根钛缆经钢板线缆通道斜向穿过小粗隆下方,收紧后将股骨与钢板固定在一起,在股骨近端用另外1根钛缆经线缆通道将股骨干与钢板固定在一起,近端因假体存在使用平头锁定螺钉单皮质固定,远端可通过微创小切口经皮置入锁定螺钉实现双皮质固定。结果所有患者均获得随访,随访时间12~27个月,平均17.8月,无切口感染、内固定及假体松动、断裂等并发症。所有患者手术均顺利完成,1例术前下肢静脉B超提示深静脉血栓,血管外科会诊后放置下肢静脉滤器后完成手术。本组手术时间110~160 min,平均128.0 min;术中出血量100~500 mL,平均370.0 mL。本组中8例术中进行输血,其中7例输2 U红细胞悬液+200 mL血浆,1例输4 U红细胞悬液+200 mL血浆;4例术后因贫血进行输血,其中3例输2 U红细胞悬液+200 mL血浆,1例输2 U红细胞悬液。本组住院时间12~20 d,平均16.0 d;骨折愈合时间4~6个月,平均4.8个月。末次随访患者髋关节功能Harris评分72~92分,平均82.2分。结论带有大粗隆钩形爪结构的新型股骨锁定钢板联合钛揽捆扎内固定治疗Vancouver B1型股骨假体周围骨折可获得骨折断端的坚强固定,加速患者早期康复,近期疗效较好。Objective To evaluate the clinical efficacy of a new femoral locking plate in combination with titanium cables for the treatment of Vancouver type B1 periprosthetic femoral fractures.Methods Clinical data of 10 patients with Vancouver type B1 periprosthetic femoral fractures treated with a new femoral locking plate in combination with titanium cables bundling from June 2019 to June 2022 were retrospectively analyzed.After fracture reduction,the locking plate was placed lateral to the femur,the proximal hook was attached to the greater trochanter.On the proximal side of the femur,1 titanium cable was passed through the channel,the femur was fixed to the plate by tensioning the titanium cable.Flat-head locking screws were used for proximal unicortical fixation,distal bicortical fixation was achieved by placing locking screws percutaneously through a small minimally invasive incision.Results All patients successfully completed the surgery with a follow-up of 12~27 months,there were no complications such as incision infection,internal fixation and prosthesis loosening or fracture.One patient had preoperative deep vein thrombosis,vein filters were placed by vascular surgery and the procedure was completed.Operative time in this group ranged from 110 to 160 minutes,intraoperative bleeding ranged from 100 to 500 mL with a mean of 370.0 mL.Intraoperative blood transfusion was performed in eight patients,seven of whom received 2 U erythrocyte suspension and 200 mL plasma,and one received 4 U erythrocyte suspension and 200 mL plasma.Four patients received postoperative blood transfusions for anemia,three with 2 U erythrocyte suspension and 200 mL plasma,and one with 2 U erythrocyte suspension.The hospital stay of our patients ranged from 12 to 20 days,and fracture healing time was 4 to 6 months with a mean of 4.8 months.At the final followup,patients had a Harris hip function score ranging from 72 to 92,the mean score was 82.2.Conclusion The new femoral locking plate combined with titanium cables bundling for the treatment

关 键 词：股骨假体周围骨折 锁定钢板 钛缆 内固定 

分 类 号：R687.3[医药卫生—骨科学]