摘要
目的探讨髋关节置换术后假体周围骨折的手术治疗方法。方法将23例髋关节置换术后假体周围骨折患者按Vancouver分型标准分为Vancouver A型12例（A组）与Vancouver B1型11例（B组）,A组采用远端固定骨水泥型加长股骨柄假体联合钢丝固定治疗;B组应用切开复位股骨近端解剖锁定板,近端单皮质锁定螺钉加钢丝捆扎,远端双皮质锁定螺丝固定,自体骨植骨或异体骨植骨治疗。并对两组手术前后Harris评分、NRS疼痛评分及手术时间、术中出血量、骨折愈合时间指标进行比较。结果两组所有病例均获随访,随访12~39个月,平均（22.7±11.6）个月,髋关节无疼痛,无跛行,功能正常,两组患者术后Harris髋关节功能评分较术前均显著提高,优良率100%,组内比较差异有统计学意义（P〈0.05）,术后A组NRS疼痛评分与B组比较明显改善,且术中出血量及骨折愈合时间均优于B组,组间比较具有显著差异性（P〈0.05）;两组手术时间比较无统计学意义（P〉0.05）。两组患者术前测量患肢较健侧短0~4 cm（平均0.8~1.0cm）,术后短缩0~1.2 cm（平均0.6cm）差异有统计学意义（P=0.002）。术后随访12个月放射学检查骨折处大量骨痂生长,钢板螺钉无松脱,假体无松动,无下沉。结论髋关节置换术后假体周围骨折可根据骨折Vancouver分型及患者具体情况选择不同的治疗方案,均可取得满意的疗效。
Objective To investigate the surgical method of periprosthetic fracture after hip replacement surgery. Methods 23 patients suffered from periprosthetic fracture after hip arthroplasty were divided into group A（ Vancouver A type,n = 12） and group B（ Vancouver B1 type,n = 11） according to the Vancouver classification standard. A group using distal fixation of bone cement type lengthening femoral stem prosthesis combined with steel wire fixation for treatment. B group using the methods including of open reduction of proximal femoral anatomical locking plate,Proximal single skin locking screw and steel wire banding,distal double skin locking screws fixed,autologous bone graft or allograft bone graft. Harris score and NRS score of the two groups before and after operation,operation time,mean bleeding volum,fracture healing time were compared. Results All cases were followed up for 2 to 39 months,with an average（ 22. 7 ± 11. 6） months,there were no hip pain and lameness occurred and the function was normal. The postoperative Harris score of hip function of the two groups were significantly improved,the excellent and good rate was 100%,the differences within groups were statistically significant（ P 0. 05）. After operation the NRS pain score of group A was significantly improved compared with the B group,mean bleeding volum and fracture healing time of group A was better than group B,the comparison between groups had significant difference（ P 0. 05）. The difference of average operating time of the two groups was not statistically significant（ P 0. 05）. Before the operation injured leg was 0 to 4 centimeters shorter than the health ones,but after the treatment the shortness decreased for 1. 2cm at most. Followed- up for12 months radiology examination of the place of fracture a found large number of bone callus growth,no loosening of the plate and screw,no loosening of the prosthesis and no sink occurred. Conclusions We can choose different treatment plan for periprosthetic fracture after hip repla
出处
《齐齐哈尔医学院学报》
2016年第9期1139-1142,共4页
Journal of Qiqihar Medical University
关键词
髋关节置换术
假体周围骨折
远端固定型股骨柄
股骨近端解剖锁定板
Hip replacement surgery
Periprosthetic fracture
The distal fixed type femoral handle
Proximal femur anatomic locking plate
