摘要
目的分析全髋关节置换术后股骨假体周围骨折的病因和治疗结果,探讨其治疗方法。方法回顾性研究自1998年12月～2003年3月治疗并随访观察的11例全髋关节置换术后股骨假体周围骨折患者,男8例,女3例,平均年龄为56岁(43～75岁),采用Vancouver分型,A型2例,B2型7例,B3型1例,C型1例。采用非手术治疗5例;手术治疗6例,其中1例为非手术治疗后骨折畸形愈合行翻修术。采用长柄假体翻修联合异体皮质骨板固定5例,其中使用非骨水泥型远端固定假体4例,使用骨水泥型假体1例。采用切开复位内固定治疗1例。结果所有病例均获随访,平均随访25.6个月(7～50个月)。9例骨折愈合,平均愈合时间4个月(3～6个月),2例骨折未愈合,均为非手术治疗病例,手术治疗6例骨折均愈合。至目前为止,7例假体稳定,1例翻修术后出现连续的影像学透亮线,3例假体松动。假体稳定的患者功能好于假体松动者,假体稳定患者的Harris评分平均91分。所有异体皮质骨板在1年内均与宿主骨整合,没有异体皮质骨板骨折发生。结论假体稳定的A型骨折可以采用非手术治疗。对于B1型和C型骨折,如无手术禁忌证,应行切开复位内固定术。对于假体松动的骨折患者,使用长柄远端固定非骨水泥型假体联合异体皮质骨板是最佳的治疗方法。
Objective To analyze the causes and results of treatment of periprosthetic femoral frac-tures after total hip arthroplasty and to explore the best operative methods for fractures. Methods 11 cases treated for periprosthetic femoral fracture after total hip arthroplasty were subjected to a retrospective fol-low-up study from December 1998 to March 2003. There were 8 men and 3 women, the mean age was 56 years (range, 43 to 75 years). There were 2 Vancouver A type fractures, 7 B2 type, 1 B3 type, 1 C type. 5 fractures were treated by nonoperative methods and other 6 by operative methods, including one fracture malunion treated initially by skin traction. There were 5 revisions using long stem supplemented with cortical allograft strut, including 4 uncemented stems with distal fixation and one cemented stem; the remaining one fracture treated by open reduction and internal fixation. Results None was lost for follow-up. The mean follow-up period was 25.6 months (range, 7 to 50 months). 9 fractures united at a mean of 4 months (range, 3 to 6 months). Nonunion was found in 2 fractures, both were treated nonoperatively. All the 6 fractures treated by operative methods united. Up to now, 7 stems were well-fixed, continuous radiolucent line was seen in one revision case, 3 stems were loosened. The function of the patients with well-fixed stems was bet-ter than those with loosened stems, the mean Harris score of the former was 91. All the cortical allograft struts were incorporated with host bone within one year. No strut fracture happened. Conclusion Type A fractures with well-fixed stems can be treated by nonoperative methods, while type B1 and type C fractures should be treated by open reduction and internal fixation, on condition there is no surgical contraindication. For fractures with loosened stems, use of an uncemented long stem with distal fixation supplemented with cortical allograft strut is the best choice.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第4期193-198,共6页
Chinese Journal of Orthopaedics
关键词
全髋关节置换术
股骨假体周围骨折
治疗
手术后
并发症
Arthroplasty, replacement, hip
Postoperative complications
Femoral fractures
Treat-ment outcome
