摘要
目的探讨更换长柄股骨假体结合内固定治疗人工髋关节置换术后假体松动型股骨假体周围骨折的疗效。方法回顾性分析2005年12月至2014年12月采用手术治疗的15例（15髋）人工髋关节置换术后假体松动型股骨假体周围骨折患者资料，男10例，女5例；年龄为64。89岁，平均76．2岁。初次手术方式：全髋关节置换术13例，生物型双极股骨头置换术2例；2例为骨水泥型假体，13例为生物型假体。骨折按照Vancouver分型：B2型9例，B3型6例。15例患者术中均更换长柄股骨假体并行骨折内固定治疗。末次随访时采用髋关节Harris评分标准评定临床疗效，采用Beals和Tower标准行假体周围骨折影像学评估，记录相关并发症的发生情况。结果除1例患者于术后4个月死亡外，其余14例患者术后获平均4．5年（6个月至9年）随访。12例患者骨折获愈合，愈合时间平均为3．9个月（3-9个月）；2例患者骨折不愈合。影像学评估结果：优9例，良3例，差2例。末次随访时髋关节Harris评分平均为82．3分（50-100分）。1例患者术前发生深静脉血栓形成，2例患者分别于术后3、10d发现胫后静脉血栓。随访期间无畸形愈合、内固定失效、脱位、假体松动等并发症发生。结论更换长柄股骨假体结合适当内固定治疗假体松动型股骨假体周围骨折可获得满意疗效。
Objective To discuss the treatment of periprosthetic femoral fractures （PFF） with unstable prosthesis by replacement of long-stem femoral prosthesis and internal fixation. Methods From December 2005 to December 2014, 15 PFF patients with unstable prosthesis （15 hips） following were treated at our de- partment. They were 10 men and 5 women, aged from 64 to 89 years （mean, 76. 2 years） . Their primary surgeries included total hip arthroplasty in 13 eases and biological bi-polar replacement of femoral head in 2. Two prostheses were cement and 13 biological. By Vancouver classification, 9 cases were type B2, and 6 type B3. The unstable prostheses in the 15 cases were replaced by long-stem femoral ones, followed by internal fixation. At the last follow-ups, clinical outcome were evaluated by Harris scoring and images of PFF by Beals ＆ Tower criteria. Complications were documented. Results One died 4 months after operation. The other 14 patients were followed up for an average of 4. 5 years （from 6 months to 9 years）. Fracture union was achieved in 12 cases after an average of 3.9 months （from 3 to 9 months）. Nonunion occurred in 2 cases. Imaging evaluation revealed 9 excellent cases, 3 good ones and 2 poor ones. The Harris scores at the last follow-up averaged was 82. 3 points （from 50 to 100 points）. Deep vein thrombosis occurred preoperatively in one case and posterior tibial vein thrombosis occurred in 2 eases respectively on day 3 and day 10 postoperatively. No such complications occurred as malunion, fixation failure, dislocation or prosthesis loosening. Conclusion Satisfactory outcomes can be achieved by replacement of long-stem femoral prosthesis combined with appropriate fixation for treatment of PFF with unstabrosthesis.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第2期169-171,共3页
Chinese Journal of Orthopaedic Trauma
关键词
关节成形术
置换
髋
股骨骨折
手术后并发症
假体和植入物
Arthroplasty, replacement, hip
Femoral fractures
Postoperative complications
Prostheses and implants
