Zweymüller型柄髋关节置换术后股骨侧假体周围骨折的手术治疗
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摘要
目的报道应用Profemur!Z柄行初次髋关节置换术后股骨侧假体周围骨折病例6例手术治疗后效果。方法纳入宁波市第六医院关节外科2009至2017年期间因终末期髋关节病或股骨颈骨折行初次髋关节置换术,术后外伤后发生假体周围骨折病例共6例(7髋)。其中5髋为长螺旋、长斜形或粉碎性骨折,2髋为短斜形骨折;Vancouver B1型2髋,B2型5髋,术中股骨侧假体根据不同骨折情况选用不同翻修方式,分别行单纯骨折复位内固定术和关节翻修术加骨折复位内固定术,并随访其疗效。结果本组患者术后随访均未出现假体松动或假体周围骨溶解等并发症,所有病例未发生术后并发症。术后3月X线显示骨折均愈合,患髋功能恢复好,末次随访髋关节功能HSS评分平均(85.5±4.5)分。结论 Profemur~Z柄初次髋关节置换术后发生假体周围骨折可根据骨折分型给予内固定或翻修手术治疗,术后随访显示功能恢复好,骨折与假体形态设计的相关性需要生物力学研究。
Objective To report therapeutic effects of surgical treatment on six cases of femoral periprosthetic fracture after primary hip arthroplasty with Profemur~ Z stem. Methods Six cases( seven hips) who received primary hip arthroplasty for end stage of hip osteopathy or femoral neck fracture were collected during 2009 to 2017. All the cases used the Profemur~ Z stem and all of them had no metabolic bone diseases but suffered from postoperative femoral periprosthetic fractures after trauma,including five hips of long spiral,long oblique or comminuted fractures and two hips of short oblique fracture. Two hips were Vancouver B1 type and five hips were B2 type. Surgeries were performed according to Vancouver classification,open reduction and internal fixation( ORIF), or revision arthroplasty plus ORIF were conducted respectively. Results No postoperative complication happened,and fractures were all healed at three months postoperatively. Good hip function was obtained in all the cases; HSS score was( 85. 5 ± 4. 5) on average at the time of latest follow-up. Conclusion The femoral periprosthetic fractures following primary hip arthroplasty with Profemur~ Z stem can be effectively l treated by surgical treatment according to Vancouver classification.
Objective To report therapeutic effects of surgical treatment on six cases of femoral periprosthetic fracture after primary hip arthroplasty with Profemur~ Z stem. Methods Six cases( seven hips) who received primary hip arthroplasty for end stage of hip osteopathy or femoral neck fracture were collected during 2009 to 2017. All the cases used the Profemur~ Z stem and all of them had no metabolic bone diseases but suffered from postoperative femoral periprosthetic fractures after trauma,including five hips of long spiral,long oblique or comminuted fractures and two hips of short oblique fracture. Two hips were Vancouver B1 type and five hips were B2 type. Surgeries were performed according to Vancouver classification,open reduction and internal fixation( ORIF), or revision arthroplasty plus ORIF were conducted respectively. Results No postoperative complication happened,and fractures were all healed at three months postoperatively. Good hip function was obtained in all the cases; HSS score was( 85. 5 ± 4. 5) on average at the time of latest follow-up. Conclusion The femoral periprosthetic fractures following primary hip arthroplasty with Profemur~ Z stem can be effectively l treated by surgical treatment according to Vancouver classification.
引文
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[4]Lowenhielm G,Hansson LI,Karrholm J.Fracture of the lower extremity after total hip replacement[J].Arch Orthop Trauma Surg,1989,108(3):141-143.
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[7]Affatato S,Comitini S,Fosco M,et al.Radiological identification of Zweymüller-type femoral stem prosthesis in revision cases[J].Int Orthop,2016,40(11):2261-2269.
[8]Busch VJ,Pouw MH,Laumen AM,et al.Long-term outcome of73 Zweymüller total hip prostheses with a screw cup in patients under 50 years of age[J].Hip Int,2012,22(3):292-295.
[9]Kolb A,Gruebl A,Schneckener CD,et al.Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem a concise follow-up,at a minimum of twenty years,of previous reports[J].J Bone Joint Surg Am,2012,94A(18):1681-1684.
[10]Silverton CD,Jacobs JJ,Devitt JW.Midterm results of a femoral stem with a modular neck design:clinical outcomes and metal ion analysis[J].Arthroplasty,2014,29(9):1768-1773.
[11]Pour AE,Borden R,Murayama TA,et al.High risk of failure with bimodular femoral components in THA[J].Clin Orthop Relat Res,2016,474(1):146-153.
[12]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[J].Bone Joint J,2016,98B(4):461-467.
[13]Grammatopoulos G,Pandit H,Kambouroglou GA,et al.A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished,tapered,collarless design of total hip replacement[J].Injury,2011,42(11):1271-1276.
[14]Sheth NP,Brown NM,Moric M,et al.Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty[J].Arthroplasty,2013,28(2):286-291.
[15]Watts CD,Abdel MP,Lewallen DG,et al.Increased risk of periprosthetic femur fractures associated with a unique cementless stem design[J].Clin Orthop Relat Res,2015,473(6):2045-2053.
[16]Hirata Y,Inaba Y,Kobayashi N,et al.Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis[J].J Arthroplasty,2013,28(10):1731-1735.
[17]Lim SJ,Lee KJ,Min BW,et al.High incidence of stem loosening in association with periprosthetic femur fractures in previously wellfixed cementless grit-blasted tapered-wedge stems[J].Int Orthop,2015,39(9):1689-1693.
[18]方超华,凌晶,李明,等.广泛多孔涂层柄应用于初次髋关节置换术后假体无菌性松动翻修的短中期疗效分析[J].中国骨与关节损伤杂志,2017,32(02):125-128.
[19]徐勇强,王愉思,阎戈,等.组配式生物型股骨假体行一期人工髋关节翻修术13例[J].中国骨与关节损伤杂志,2012,27(12):1102-1103.
[20]王健,肖军,赵亮,等.非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的作用[J].中华骨科杂志,2016,36(23):1517-1523.
[2]Lindahl H,Garellick G,Regner H,et al.Three hundred and twenty-one periprosthetic femoral fractures[J].J Bone Joint Surge Am,2006,88A(6):1215-1222.
[3]Abdel MP,Cottino U,Mabry TM.Management of periprosthetic femoral fractures following total hip arthroplasty:a review[J].Int Orthop,2015,39(10):2005-2010.
[4]Lowenhielm G,Hansson LI,Karrholm J.Fracture of the lower extremity after total hip replacement[J].Arch Orthop Trauma Surg,1989,108(3):141-143.
[5]Duncan CP,Masri BA.Fractures of the femur after hip replacement[J].Instr Course Lect,1995,44:293-304.
[6]Bohm G,Lintner F,Auterith A,et al.Morphometric examination of straight,tapered Titanium stems-A retrieval study[J].Clin Orthop Relat Res,2001,393:13-24.
[7]Affatato S,Comitini S,Fosco M,et al.Radiological identification of Zweymüller-type femoral stem prosthesis in revision cases[J].Int Orthop,2016,40(11):2261-2269.
[8]Busch VJ,Pouw MH,Laumen AM,et al.Long-term outcome of73 Zweymüller total hip prostheses with a screw cup in patients under 50 years of age[J].Hip Int,2012,22(3):292-295.
[9]Kolb A,Gruebl A,Schneckener CD,et al.Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem a concise follow-up,at a minimum of twenty years,of previous reports[J].J Bone Joint Surg Am,2012,94A(18):1681-1684.
[10]Silverton CD,Jacobs JJ,Devitt JW.Midterm results of a femoral stem with a modular neck design:clinical outcomes and metal ion analysis[J].Arthroplasty,2014,29(9):1768-1773.
[11]Pour AE,Borden R,Murayama TA,et al.High risk of failure with bimodular femoral components in THA[J].Clin Orthop Relat Res,2016,474(1):146-153.
[12]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[J].Bone Joint J,2016,98B(4):461-467.
[13]Grammatopoulos G,Pandit H,Kambouroglou GA,et al.A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished,tapered,collarless design of total hip replacement[J].Injury,2011,42(11):1271-1276.
[14]Sheth NP,Brown NM,Moric M,et al.Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty[J].Arthroplasty,2013,28(2):286-291.
[15]Watts CD,Abdel MP,Lewallen DG,et al.Increased risk of periprosthetic femur fractures associated with a unique cementless stem design[J].Clin Orthop Relat Res,2015,473(6):2045-2053.
[16]Hirata Y,Inaba Y,Kobayashi N,et al.Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis[J].J Arthroplasty,2013,28(10):1731-1735.
[17]Lim SJ,Lee KJ,Min BW,et al.High incidence of stem loosening in association with periprosthetic femur fractures in previously wellfixed cementless grit-blasted tapered-wedge stems[J].Int Orthop,2015,39(9):1689-1693.
[18]方超华,凌晶,李明,等.广泛多孔涂层柄应用于初次髋关节置换术后假体无菌性松动翻修的短中期疗效分析[J].中国骨与关节损伤杂志,2017,32(02):125-128.
[19]徐勇强,王愉思,阎戈,等.组配式生物型股骨假体行一期人工髋关节翻修术13例[J].中国骨与关节损伤杂志,2012,27(12):1102-1103.
[20]王健,肖军,赵亮,等.非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的作用[J].中华骨科杂志,2016,36(23):1517-1523.