锁定钢板固定联合同种异体皮质骨板治疗髋关节置换后老年骨质疏松性Vancouver B1、C型股骨假体周围骨折
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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.
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
[1]王俏杰,张先龙.人工髋关节置换术的现状与热点[J].中华关节外科杂志(电子版),2015,9(6):718-724.
[2]Giesinger K,Ebneter L,Day RE,et al.Can plate osteosynthesis of periprosthethic femoral fractures cause cement mantle failure around a stable hip stem?Abiomechanical analysis.J Arthroplasty.2014;29(6):1308-1312.
[3]Hagel A,Siekmann H,Delank KS.Periprosthetic femoral fracture-an interdisciplinary challenge.Dtsch Arztebl Int.2014;111(39):658-664.
[4]Pivec R,Issa K,Kapadia BH,et al.Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty:an analysis of international egistry data.J Long Term Eff Med Implants.2015;25(4):269-275.
[5]Lindahl H,Malchau H,Herberts P,et al.Periprosthetic femoral fractures classification and demographics of 1049periprosthetic femoral fractures from the swedish national hip arthroplasty register.J Arthroplasty.2005;20:857-865.
[6]郭涛,张亚奎,张星火,等.人工髋关节置换术发生股骨假体周围骨折的影响因素分析[J].现代生物医学进展,2016,16(9):1731-1733.
[7]张应彬,郑鸣,李嘉易,等.髋关节置换术后股骨假体周围骨折的临床治疗分析[J].中华关节外科杂志(电子版),2018,12(3):411-415.
[8]Gromov K,Bersang A,Nielsen CS,et al.Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component.Bone Joint J.2017;99-B(4):451.
[9]董炳辰,邵林.不同假体类型对股骨假体周围骨折的影响[J].医学综述,2018,24(12):2411-2415.
[10]王国伟.三种不同内固定方式作用于髋关节假体周围B1型骨折的有限元分析及新型假体周围板的设计与改良[D].济南:山东大学,2016.
[11]徐小平,刘战立,常山,等.钛缆钢板结合抗骨质疏松治疗Vancouver B1型股骨假体周围骨折[J].实用骨科杂志,2015,21(5):402-405.
[12]Phillips JR,Moran CG,Manktelow AR.Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture.Injury.2013;44(6):757-762.
[13]Fuchtmeier B,Galler M,Muller F.Mid-term results of 121periprosthetic femoral fractures:increased failure and mortality within but not after one postoperative year.JArthroplasty.2015;30(4):669-674.
[14]裴福兴,康鹏德.髋关节翻修相关问题[J].中国骨与关节损伤杂志,2010,25(4):377-378.
[15]许福生,刘方刚,祁伟,髋关节置换术后股骨假体周围骨折的诊疗进展[J].中华关节外科杂志(电子版),2015,4(9):536-538.
[16]熊建,芦浩,付中国,等.髋关节置换术后股骨假体周围骨折的治疗进展[J].现代实用医学,2015,27(2):137-139.
[17]Rayan F,Dodd M,Haddad FS.European validation of the Vancouver classification of periprosthetic proximal femoral fractures.J Bone Joint Surg Br.2008;90:1576-1579.
[18]张振东.人工全髋关节股骨假体周围骨折的临床特点研究及其危险因素分析[D].北京:中国人民解放军医学院,2015.
[19]顾航宇,李庭,赵春鹏,吴新宝.髋关节假体周围骨折的治疗现状及进展[J].骨科临床与研究杂志,2018,3(2):119-128.
[20]Abdel MP,Watts CD,Houdek MT,et al.Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties:a 40-year experience.Bone Joint J.2016;98-B(4):461.
[21]张盼,李同林,魏成建.全髋关节术后假体周围骨折治疗进展[J].中国中西医结合外科杂志,2014,20(4):449-452.
[22]刘恒,王建伟.髋关节置换术后股骨假体周围骨折的分型及治疗的研究进展[J].创伤外科杂志,2016,18(10):632-634.
[23]陈奇,陈卫,丁真奇,等.钢板结合异体骨板对粉碎性Vancouver B1型假体周围股骨骨折的疗效观察[J].中国骨伤,2016,29(8):734-737.
[24]Takahiro N,Atsushi S,Keisuke O,et al.Clinical and radiological results of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties:a retrospective multi-center study.J Orthop Sci.2014;6(9):984-990.
[25]Khan T,Grindlay D,Ollivere BJ,et al.A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures.Hip.2017;4(99):17-23.
[26]尹飚,杨波,丁强,等.钛缆锁定钢板治疗老年骨质疏松性Vancouver B1型股骨假体周围骨折的效果[J].广东医学,2014,35(20):3162-3164.
[27]Cohen S,Flecher X,Parratte S,et al.Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture.A comparative study of 71 fractures treated by internal fixation or femoral implant revision.Orthop Traumatol Surg Res.2018;104(3):363-367.
[28]钟航,杨静,裴福兴,等.皮质骨板联合髁钢板治疗全膝置换术后股骨假体周围骨折[J].实用骨科杂志,2016,22(3):225-228.
[29]周乙雄,吕明.全髋关节置换术后股骨假体周围骨折的治疗[J].中华骨科杂志,2004,24(4):4-9.
[30]周宗科,裴福兴,屠重棋,等.同种异体皮质骨板移植治疗股骨假体周围骨折[J].中华外科杂志,2004,42(24):9-12.
[31]郜振武,吴斗,郭军政,等.骨质疏松性股骨侧假体周围骨折的治疗及策略[J].中华关节外科杂志(电子版),2015,9(5):680-684.
[32]马成.髋关节置换术后假体周围骨折三种内固定方式的生物力学研究[D].石家庄:河北医科大学,2016.
[33]Zdero R,Walker R,Waddell JP,et al.Biomechanical evaluation of periprosthetic femoral fracture fixation.J Bone Joint Surg.2008;90(5):1068-1077.
[34]沈兵.桥接系统治疗VancouverB1、C型股骨假体周围骨折的疗效分析[D].昆明:云南中医学院,2017.
[35]Haddad FS,Duncan CP,Berry DJ,et al.Periprosthetic femoral fractures around well-fixed implants:use of cortical onlay allografts with or without a plate.J Bone Joint Surg.2002;84(6):945.
[36]Kim YH,Mansukhani SA,Kim JS,et al.Use of Locking Plate and Strut Onlay Allografts For Periprosthetic Fracture Around Well-Fixed Femoral Components.J Arthroplasty.2017;32(1):166-170.
[37]Lindahl H,Malchau H,Odén A,et al.Risk factors for failure after treatment of a periprosthetic fracture of the femur.JBone Joint Surg Br.2006;88:26-30.
[38]Tower SS,Beals RK.Fractures of the femur after hip replacement:the oregon experience.Orthop Clin North Am.1999;30:235-247.
[39]周宗科,裴福兴,程惊秋,等.同种异体皮质骨板移植免疫学研究[J].中国矫形外科杂志,2005,13(3):201-203.
[40]Corten K,Vanrykel F,Bellemans J,et al.An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.J Bone Joint Surg.2009;91(11):1424-1430.
[41]杨德育,尤瑞金,王月娥,等.钛缆结合记忆合金环抱器治疗Vancouver B1型股骨假体周围骨折[J].中国矫形外科杂志,2016,24(10):878-883.
[42]Haddad FS,Garbuz DS,Masri BA,et al.Structural proximal femoral allografts for failed total hip replacements:a minimum review of five years.J Bone Joint Surg.2000;82(6):830-836.
[2]Giesinger K,Ebneter L,Day RE,et al.Can plate osteosynthesis of periprosthethic femoral fractures cause cement mantle failure around a stable hip stem?Abiomechanical analysis.J Arthroplasty.2014;29(6):1308-1312.
[3]Hagel A,Siekmann H,Delank KS.Periprosthetic femoral fracture-an interdisciplinary challenge.Dtsch Arztebl Int.2014;111(39):658-664.
[4]Pivec R,Issa K,Kapadia BH,et al.Incidence and future projections of periprosthetic femoral fracture following primary total hip arthroplasty:an analysis of international egistry data.J Long Term Eff Med Implants.2015;25(4):269-275.
[5]Lindahl H,Malchau H,Herberts P,et al.Periprosthetic femoral fractures classification and demographics of 1049periprosthetic femoral fractures from the swedish national hip arthroplasty register.J Arthroplasty.2005;20:857-865.
[6]郭涛,张亚奎,张星火,等.人工髋关节置换术发生股骨假体周围骨折的影响因素分析[J].现代生物医学进展,2016,16(9):1731-1733.
[7]张应彬,郑鸣,李嘉易,等.髋关节置换术后股骨假体周围骨折的临床治疗分析[J].中华关节外科杂志(电子版),2018,12(3):411-415.
[8]Gromov K,Bersang A,Nielsen CS,et al.Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component.Bone Joint J.2017;99-B(4):451.
[9]董炳辰,邵林.不同假体类型对股骨假体周围骨折的影响[J].医学综述,2018,24(12):2411-2415.
[10]王国伟.三种不同内固定方式作用于髋关节假体周围B1型骨折的有限元分析及新型假体周围板的设计与改良[D].济南:山东大学,2016.
[11]徐小平,刘战立,常山,等.钛缆钢板结合抗骨质疏松治疗Vancouver B1型股骨假体周围骨折[J].实用骨科杂志,2015,21(5):402-405.
[12]Phillips JR,Moran CG,Manktelow AR.Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture.Injury.2013;44(6):757-762.
[13]Fuchtmeier B,Galler M,Muller F.Mid-term results of 121periprosthetic femoral fractures:increased failure and mortality within but not after one postoperative year.JArthroplasty.2015;30(4):669-674.
[14]裴福兴,康鹏德.髋关节翻修相关问题[J].中国骨与关节损伤杂志,2010,25(4):377-378.
[15]许福生,刘方刚,祁伟,髋关节置换术后股骨假体周围骨折的诊疗进展[J].中华关节外科杂志(电子版),2015,4(9):536-538.
[16]熊建,芦浩,付中国,等.髋关节置换术后股骨假体周围骨折的治疗进展[J].现代实用医学,2015,27(2):137-139.
[17]Rayan F,Dodd M,Haddad FS.European validation of the Vancouver classification of periprosthetic proximal femoral fractures.J Bone Joint Surg Br.2008;90:1576-1579.
[18]张振东.人工全髋关节股骨假体周围骨折的临床特点研究及其危险因素分析[D].北京:中国人民解放军医学院,2015.
[19]顾航宇,李庭,赵春鹏,吴新宝.髋关节假体周围骨折的治疗现状及进展[J].骨科临床与研究杂志,2018,3(2):119-128.
[20]Abdel MP,Watts CD,Houdek MT,et al.Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties:a 40-year experience.Bone Joint J.2016;98-B(4):461.
[21]张盼,李同林,魏成建.全髋关节术后假体周围骨折治疗进展[J].中国中西医结合外科杂志,2014,20(4):449-452.
[22]刘恒,王建伟.髋关节置换术后股骨假体周围骨折的分型及治疗的研究进展[J].创伤外科杂志,2016,18(10):632-634.
[23]陈奇,陈卫,丁真奇,等.钢板结合异体骨板对粉碎性Vancouver B1型假体周围股骨骨折的疗效观察[J].中国骨伤,2016,29(8):734-737.
[24]Takahiro N,Atsushi S,Keisuke O,et al.Clinical and radiological results of locking plate fixation for periprosthetic femoral fractures around hip arthroplasties:a retrospective multi-center study.J Orthop Sci.2014;6(9):984-990.
[25]Khan T,Grindlay D,Ollivere BJ,et al.A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures.Hip.2017;4(99):17-23.
[26]尹飚,杨波,丁强,等.钛缆锁定钢板治疗老年骨质疏松性Vancouver B1型股骨假体周围骨折的效果[J].广东医学,2014,35(20):3162-3164.
[27]Cohen S,Flecher X,Parratte S,et al.Influence of treatment modality on morbidity and mortality in periprosthetic femoral fracture.A comparative study of 71 fractures treated by internal fixation or femoral implant revision.Orthop Traumatol Surg Res.2018;104(3):363-367.
[28]钟航,杨静,裴福兴,等.皮质骨板联合髁钢板治疗全膝置换术后股骨假体周围骨折[J].实用骨科杂志,2016,22(3):225-228.
[29]周乙雄,吕明.全髋关节置换术后股骨假体周围骨折的治疗[J].中华骨科杂志,2004,24(4):4-9.
[30]周宗科,裴福兴,屠重棋,等.同种异体皮质骨板移植治疗股骨假体周围骨折[J].中华外科杂志,2004,42(24):9-12.
[31]郜振武,吴斗,郭军政,等.骨质疏松性股骨侧假体周围骨折的治疗及策略[J].中华关节外科杂志(电子版),2015,9(5):680-684.
[32]马成.髋关节置换术后假体周围骨折三种内固定方式的生物力学研究[D].石家庄:河北医科大学,2016.
[33]Zdero R,Walker R,Waddell JP,et al.Biomechanical evaluation of periprosthetic femoral fracture fixation.J Bone Joint Surg.2008;90(5):1068-1077.
[34]沈兵.桥接系统治疗VancouverB1、C型股骨假体周围骨折的疗效分析[D].昆明:云南中医学院,2017.
[35]Haddad FS,Duncan CP,Berry DJ,et al.Periprosthetic femoral fractures around well-fixed implants:use of cortical onlay allografts with or without a plate.J Bone Joint Surg.2002;84(6):945.
[36]Kim YH,Mansukhani SA,Kim JS,et al.Use of Locking Plate and Strut Onlay Allografts For Periprosthetic Fracture Around Well-Fixed Femoral Components.J Arthroplasty.2017;32(1):166-170.
[37]Lindahl H,Malchau H,Odén A,et al.Risk factors for failure after treatment of a periprosthetic fracture of the femur.JBone Joint Surg Br.2006;88:26-30.
[38]Tower SS,Beals RK.Fractures of the femur after hip replacement:the oregon experience.Orthop Clin North Am.1999;30:235-247.
[39]周宗科,裴福兴,程惊秋,等.同种异体皮质骨板移植免疫学研究[J].中国矫形外科杂志,2005,13(3):201-203.
[40]Corten K,Vanrykel F,Bellemans J,et al.An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.J Bone Joint Surg.2009;91(11):1424-1430.
[41]杨德育,尤瑞金,王月娥,等.钛缆结合记忆合金环抱器治疗Vancouver B1型股骨假体周围骨折[J].中国矫形外科杂志,2016,24(10):878-883.
[42]Haddad FS,Garbuz DS,Masri BA,et al.Structural proximal femoral allografts for failed total hip replacements:a minimum review of five years.J Bone Joint Surg.2000;82(6):830-836.