摘要
背景:随着人工髋关节置换的数量快速增长,股骨假体周围骨折的数量也逐年上升,由于此类患者多为高龄,常合并重度骨质疏松,治疗上存在较大的困难,是临床关节外科医生的一个挑战。目的:探讨应用同种异体皮质骨板联合锁定钢板捆扎治疗髋关节置换后骨质疏松性B1、C型股骨假体周围骨折的临床疗效。方法:回顾性分析福建中医药大学附属泉州市正骨医院2014年8月至2017年7月收治的13例骨质疏松性Vancouver B1、C型股骨假体周围骨折病例的临床资料,所有患者均采用同种异体皮质骨板联合锁定钢板+钢丝或钛缆捆扎固定,联合抗骨质疏松治疗。术后随访行Harris评分评估患者功能恢复情况,X射线片检查评价骨折和骨板愈合、内固定及假体位置情况。结果与结论:(1)患者随访时间12-46个月;(2)患者术后6个月Harris评分高于术后1个月,差异有显著性意义(t=-13.38,P=0.000);末次随访Harris评分高于术后6个月,差异有显著性意义(t=-5.59,P=0.01);(3)所有病例未出现内固定失效,至术后6个月随访时骨折均达临床愈合;末次随访未见假体及内固定物松动,同种异体骨板与宿主骨愈合,并不同程度的塑形,患髋无明显疼痛,均可下地行走;(4)提示髋关节置换后骨质疏松性B1、C型股骨假体周围骨折采取同种异体皮质骨板联合锁定钢板捆扎治疗可获得良好的修复效果。
BACKGROUND: With the rapid growth of hip arthroplasty, the number of periprosthetic femoral fractures is increasing yearly. Because most of patients are older adults complicated with severe osteoporosis, the treatment is difficult, which is a challenge for clinical joint surgeons. OBJECTIVE: To evaluate the curative effectiveness of allogeneic cortical bone plate combined with locking plate for Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty. METHODS: Clinical data of 13 patients with Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty at Quanzhou Orthopedic-Traumatological Hospital of Fujian University of Traditional Chinese Medicine between August 2014 and July 2017 were collected. All patients were treated with allogeneic cortical bone plate combined with locking plate, also with anti-osteoporosis treatment. The joint function was assessed by Harris hip score. The fracture and allogenic bone plate healing, prosthesis and internal fixation position, and prosthetic loosening were evaluated by X-ray. RESULTS AND CONCLUSION:(1) The follow-up time was 12-46 months.(2) The Harris hip score at postoperative 6 months was significantly higher than that at 1 month postoperatively(t=-13.38, P=0.000). The score at last follow-up was significantly higher than that at 6 months postoperatively(t=-5.59, P=0.01).(3) All fractures were healed at 6 months after operation, no loosening of prosthesis or internal fixator was found, bone plate of allograft healed with host bone, and different degrees of modeling were observed at the last follow-up. All patients could walk painlessly.(4) These results indicate that allogeneic cortical bone plate combined with locking plate for Vancouver type B1 and C osteoporotic periprosthetic femoral fractures after hip arthroplasty shows good clinical efficacy.
引文
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