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髋关节置换术后股骨假体周围骨折的手术治疗

ISSN号：1671-167X
期刊名称：北京大学学报(医学版)
时间：2012.11
页码：874-877
分类：R687.42[医药卫生—骨科学;医药卫生—临床医学;医药卫生—外科学]
作者机构：[1]北京大学人民医院创伤骨科,北京大学交通医学中心,北京100044
相关基金：卫生公益型行业科研专项（201002014）; “十一五”国家科技支撑计划重点项目（2007BAI04B00）; 国家重点基础研究发展计划（973计划,2005CB522604）; 北京市科技新星计划（A-2008-10）; 新世纪优秀人才支持计划项目（BMU20110270）; 北京市科技支撑、市政府重点工作项目（Z101107052210001）资助
相关项目：恒河猴周围神经有髓神经纤维倍数再生修复周围神经损伤的机制研究

关键词：关节成形术, 置换, 髋, 假体周围骨折, 股骨, 外科手术, Arthroplasty, replacement, hip, Periprosthetic fractures, Femur, Surgical procedures, operative

中文摘要：

目的：探讨髋关节置换术后股骨假体周围骨折的手术治疗效果。方法：2006年10月至2012年1月手术治疗的10例股骨假体周围骨折的患者,依据Vancouver分型采用不同的治疗方法,对患者术后骨折愈合情况、髋关节功能、骨折部位疼痛和肢体长度进行评价。结果：随访时间6～69个月,平均35.1月。所有患者的骨折均达愈合,对位和对线良好,无假体松动以及内固定断裂或移位。髋关节Harris评分71～90分,平均79.8分,优良率达到70%。负重行走时骨折部位疼痛情况视觉模拟评分（visual analogue scale,VAS）0～3分,平均1.4分。假体周围骨折术前测量患侧肢体较对侧肢体短缩0～2.5 cm,平均（1.6±0.9）cm;术后随访时短缩0～1.8 cm,平均（0.6±0.6）cm,同术前相比差异有统计学意义（P=0.002）。结论：髋关节置换术后股骨假体周围骨折临床治疗难度较大,可根据患者年龄、一般情况、功能要求以及骨折的Vancouver分型选择个体化的治疗方案,手术治疗可取得满意的疗效。

英文摘要：

Objective：To investigate the surgical treatment results of periprosthetic femur fracture after hip arthroplasty.Methods：In the study,10 patients from Oct.2006 to Jan.2012 were treated surgically according to Vancouver classification,and their fracture union,hip function,pain in fracture site and lower extremity length were evaluated postoperatively.Results：All the patients had full follow-up for 6 to 69 months（mean time：35.1 months）.All fractures were united well with good alignment and no prosthesis loosing or internal fixation failure was discovered.Harris scores to assess hip function were 71 to 90（mean：79.8） and the excellent and good rate was 70%.VAS scores to evaluate pain in fracture site when walking were 0 to 3（mean：1.4）.The lengths of injured lower extremity were shorter by 0 to 2.5 cm than those of the contralateral side pre-operatively [mean（1.6±0.9） cm].The shortened lengths were reduced to 0 to 1.8 cm post-operatively [mean（0.6±0.6） cm],which were statistically different from those of pre-operation（P=0.002）.Conclusion：Although treatment of periprosthetic femur fracture after hip arthroplasty is a hard work,we can make individual therapy regiment based on the patient＇s age,general condition,function demand and Vancouver classification.Surgical treatment can bring good results.

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