组配式股骨假体髋关节翻修治疗全髋关节置换术后股骨假体周围骨折的近中期效果分析
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摘要
目的分析组配式股骨假体髋关节翻修治疗全髋关节置换术后股骨假体周围骨折的近中期效果。方法回顾性分析2013年6月—2016年6月我院行组配式股骨假体髋关节翻修治疗的全髋关节置换术后股骨假体周围骨折20例临床资料,观察患者手术时间、术中出血量、输血量、住院时间,术前、术后髋关节HHS评分、PPMS评分、疼痛视觉模拟评分(visual analogue scale, VAS)及手术并发症发生情况。结果 20例均顺利完成手术,手术时间42.56～80.45(64.35±20.23)min,术中出血量976.46～2988.79(2001.34±986.45)ml,输血量452.14～1485.34(963.14±512.42)ml,住院时间7.50～18.50(14.23±4.82)d;20例术后HHS及PPMS评分均高于术前,术后VAS评分低于术前,差异均有统计学意义(P<0.01);术中未发生血管、神经损伤,术后随访期间未发生假体周围感染、松动、脱位、骨折不愈合及再骨折等并发症。结论全髋关节置换术后股骨假体周围骨折应用组配式股骨假体进行髋关节翻修治疗的近中期效果满意,且操作简单,可获得良好的骨折初始稳定性。
Objective To analyze the short and moderate term effect of modular femoral prosthesis in hip revision in the treatment of periprosthetic femoral fractures after total hip replacement. Methods The clinical data of 20 patients with periprosthetic femoral fractures undergoing total hip replacement in our hospital from June 2013 to June 2016 were retrospectively analyzed. The duration of operation, intraoperative blood loss, blood transfusion volume, length of hospitalization, as well as harris hip score(HHS), parker palmer mobility score(PPMS), and visual analogue scale(VAS) score before and after treatment and the occurrence of surgical complications were observed. Results All the 20 cases successfully underwent the surgery. The duration of operation was 42.56-80.45(64.35±20.23) min, the intraoperative blood loss was 976.46-2988.79(2001.34±986.45) ml, the blood transfusion volume was 452.14-1485.34(963.14±512.42) ml, and the length of hospitalization was 7.50-18.50(14.23±4.82) d. The HHS and PPMS scores of the 20 patients were higher than those before operation, and the postoperative VAS scores were lower than that before surgery. The differences were statistically significant(P<0.01). No vascular injury or nerve injury was found during the operation. There were no complications such as periprosthetic infection, loosening, dislocation, nonunion or re-fracture during the follow-up. Conclusion The short and moderate term effect of modular femoral prosthesis in hip revision on periprosthetic femoral fractures after total hip replacement is satisfactory, and the operation is handy. Therefore, the initial stability of the fracture is good.
Objective To analyze the short and moderate term effect of modular femoral prosthesis in hip revision in the treatment of periprosthetic femoral fractures after total hip replacement. Methods The clinical data of 20 patients with periprosthetic femoral fractures undergoing total hip replacement in our hospital from June 2013 to June 2016 were retrospectively analyzed. The duration of operation, intraoperative blood loss, blood transfusion volume, length of hospitalization, as well as harris hip score(HHS), parker palmer mobility score(PPMS), and visual analogue scale(VAS) score before and after treatment and the occurrence of surgical complications were observed. Results All the 20 cases successfully underwent the surgery. The duration of operation was 42.56-80.45(64.35±20.23) min, the intraoperative blood loss was 976.46-2988.79(2001.34±986.45) ml, the blood transfusion volume was 452.14-1485.34(963.14±512.42) ml, and the length of hospitalization was 7.50-18.50(14.23±4.82) d. The HHS and PPMS scores of the 20 patients were higher than those before operation, and the postoperative VAS scores were lower than that before surgery. The differences were statistically significant(P<0.01). No vascular injury or nerve injury was found during the operation. There were no complications such as periprosthetic infection, loosening, dislocation, nonunion or re-fracture during the follow-up. Conclusion The short and moderate term effect of modular femoral prosthesis in hip revision on periprosthetic femoral fractures after total hip replacement is satisfactory, and the operation is handy. Therefore, the initial stability of the fracture is good.
引文
[1] 程鹏,王玮琪.骨折内固定术与全髋关节置换术治疗老年股骨颈骨折的临床效果比较[J].中华全科医学,2016,14(4):689-691.
[2] Yu W, Zhang X, Zhu X, et al. Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up[J].BMC Musculoskelet Disord, 2016,17:222.
[3] 程琪,郑欣,郭开今,等.组配式股骨假体在人工髋关节置换术后股骨假体周围骨折翻修中的应用[J].中华骨科杂志,2017,37(15):921-928.
[4] 王金良,骆晓飞,魏瑄,等.更换长柄股骨假体结合内固定治疗假体松动型股骨假体周围骨折[J].中华创伤骨科杂志,2016,18(2):169-171.
[5] 杨二平,彭昊,杜远立,等.非骨水泥长柄股骨假体治疗Vancouver B型股骨假体周围骨折[J].海南医学,2016,27(9):1436-1438.
[6] 孙卫平,王海波,王善超.组配式S-ROM假体结合粗隆下截骨治疗CroweⅣ型髋关节发育不良的疗效分析[J].中国矫形外科杂志,2016,24(1):13-17.
[7] 张立,吴显培,王代荣,等.空心钉锁定板与空心加压螺钉治疗无移位型股骨颈骨折的效果分析[J].解放军医药杂志,2017,29(8):30-33.
[8] 胡云根,韩雷,方伟利,等.解剖型锁定钢板及Gamma钉治疗伴有外侧壁骨折股骨转子间骨折的病例对照研究[J].中国骨伤,2016,29(6):496-501.
[9] 宋留红,刘彬,史艳光,等.椎弓根钉联合伤椎自体骨移植与联合注射性硫酸钙治疗胸腰椎骨折的对比研究[J].解放军医药杂志,2017,29(1):71-75.
[10] Marczak D, Synder M, Sibinski M, et al. Comparison of patients treated with or without a spacer in two stage revision hip arthroplasty for periprosthetic joint infection[J].J Infect, 2016,73(5):520-522.
[11] 成亮,邹天明,蔡小强,等.大直径股骨头假体在人工全髋关节置换术后早期不稳定翻修术中应用[J].现代仪器与医疗,2016,22(6):80-81,96.
[12] 李博,田晓滨,孙立,等.骨水泥型与生物型加长柄人工髋关节置换术治疗高龄不稳定股骨转子间骨折的疗效比较[J].中华创伤杂志,2016,32(6):527-532.
[13] 马川,江锋,黄陈翼,等.骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究[J].检验医学与临床,2016,13(13):1826-1828.
[14] 徐立娜,贠振楠,徐长妍,等.不同假体类型对人工髋关节置换术治疗老年股骨头缺血性坏死疗效的影响[J].中国老年学杂志,2016,36(19):4847-4848.
[15] 郑汉龙,黄勇,邵宏翊,等.生物型组配式股骨柄在Vancouver B2、B3型股骨假体周围骨折关节翻修术中的应用[J].中华骨科杂志,2017,37(15):914-920.
[16] 王金良,骆晓飞,魏瑄,等.更换长柄股骨假体结合内固定治疗假体松动型股骨假体周围骨折[J].中华创伤骨科杂志,2016,18(2):169-171.
[17] 李儒军,林剑浩,寇伯龙,等.人工髋关节置换术后股骨假体周围骨折的手术治疗[J].中华骨科杂志,2017,37(15):906-913.
[18] 范书勇,李岩,罗鸣,等.锁定加压钢板行微创技术治疗老年性股骨远端骨折临床疗效分析[J].现代生物医学进展,2016,16(11):2095-2098,2133.
[19] 廖乐明,蔡迅梓,吴浩波,等.手术治疗全髋关节置换术后VancouverB1型股骨假体周围骨折[J].中华骨科杂志,2017,37(15):936-941.
[20] 顾建明,黄勇,杜辉,等.重建组配股骨假体在髋关节翻修术中的应用[J].中华骨科杂志,2017,37(23):1458-1465.
[2] Yu W, Zhang X, Zhu X, et al. Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up[J].BMC Musculoskelet Disord, 2016,17:222.
[3] 程琪,郑欣,郭开今,等.组配式股骨假体在人工髋关节置换术后股骨假体周围骨折翻修中的应用[J].中华骨科杂志,2017,37(15):921-928.
[4] 王金良,骆晓飞,魏瑄,等.更换长柄股骨假体结合内固定治疗假体松动型股骨假体周围骨折[J].中华创伤骨科杂志,2016,18(2):169-171.
[5] 杨二平,彭昊,杜远立,等.非骨水泥长柄股骨假体治疗Vancouver B型股骨假体周围骨折[J].海南医学,2016,27(9):1436-1438.
[6] 孙卫平,王海波,王善超.组配式S-ROM假体结合粗隆下截骨治疗CroweⅣ型髋关节发育不良的疗效分析[J].中国矫形外科杂志,2016,24(1):13-17.
[7] 张立,吴显培,王代荣,等.空心钉锁定板与空心加压螺钉治疗无移位型股骨颈骨折的效果分析[J].解放军医药杂志,2017,29(8):30-33.
[8] 胡云根,韩雷,方伟利,等.解剖型锁定钢板及Gamma钉治疗伴有外侧壁骨折股骨转子间骨折的病例对照研究[J].中国骨伤,2016,29(6):496-501.
[9] 宋留红,刘彬,史艳光,等.椎弓根钉联合伤椎自体骨移植与联合注射性硫酸钙治疗胸腰椎骨折的对比研究[J].解放军医药杂志,2017,29(1):71-75.
[10] Marczak D, Synder M, Sibinski M, et al. Comparison of patients treated with or without a spacer in two stage revision hip arthroplasty for periprosthetic joint infection[J].J Infect, 2016,73(5):520-522.
[11] 成亮,邹天明,蔡小强,等.大直径股骨头假体在人工全髋关节置换术后早期不稳定翻修术中应用[J].现代仪器与医疗,2016,22(6):80-81,96.
[12] 李博,田晓滨,孙立,等.骨水泥型与生物型加长柄人工髋关节置换术治疗高龄不稳定股骨转子间骨折的疗效比较[J].中华创伤杂志,2016,32(6):527-532.
[13] 马川,江锋,黄陈翼,等.骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究[J].检验医学与临床,2016,13(13):1826-1828.
[14] 徐立娜,贠振楠,徐长妍,等.不同假体类型对人工髋关节置换术治疗老年股骨头缺血性坏死疗效的影响[J].中国老年学杂志,2016,36(19):4847-4848.
[15] 郑汉龙,黄勇,邵宏翊,等.生物型组配式股骨柄在Vancouver B2、B3型股骨假体周围骨折关节翻修术中的应用[J].中华骨科杂志,2017,37(15):914-920.
[16] 王金良,骆晓飞,魏瑄,等.更换长柄股骨假体结合内固定治疗假体松动型股骨假体周围骨折[J].中华创伤骨科杂志,2016,18(2):169-171.
[17] 李儒军,林剑浩,寇伯龙,等.人工髋关节置换术后股骨假体周围骨折的手术治疗[J].中华骨科杂志,2017,37(15):906-913.
[18] 范书勇,李岩,罗鸣,等.锁定加压钢板行微创技术治疗老年性股骨远端骨折临床疗效分析[J].现代生物医学进展,2016,16(11):2095-2098,2133.
[19] 廖乐明,蔡迅梓,吴浩波,等.手术治疗全髋关节置换术后VancouverB1型股骨假体周围骨折[J].中华骨科杂志,2017,37(15):936-941.
[20] 顾建明,黄勇,杜辉,等.重建组配股骨假体在髋关节翻修术中的应用[J].中华骨科杂志,2017,37(23):1458-1465.