LISS系统治疗Rorabeck Ⅱ型股骨远端假体周围骨折的疗效分析
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摘要
目的探讨全膝关节置换术后Rorabeck Ⅱ型股骨假体周围骨折的治疗方法及效果。方法对收治的人工膝关节置换术后股骨假体周围骨折患者9例(Rorabeck Ⅱ型),采用微创内固定稳定系统(LISS系统)内固定术治疗。随访时间12～60个月,平均(32. 3±14. 1)个月,在术后测量9例患者的膝关节活动范围、肢体力线,并采用美国特种外科医院膝关节评分(HSS)评定患者的膝关节功能。结果 8例患者的骨折均愈合,患者的平均HSS评分为83. 2分,1例患者因LISS钢板松动导致骨折畸形愈合,再次入院后行长柄限制性假体置换术。结论术前应根据此型骨折特点全面计划,选择LISS钢板内固定治疗全膝关节置换术后Rorabeck Ⅱ型股骨假体周围骨折,创伤少、内固定可靠,可获满意效果。
Objective To investigate the treatments and outcomes of Rorabeck type Ⅱ periprosthetic distal femur fracture after total knee arthroplasty( TKA). Methods A total of 9 patients( Rorabeck type Ⅱ) who suffered femoral prosthesis fracture after TKA from June 2012 to May 2017 were included,with follow-up of 32. 3 ± 14. 1 months( 12-60). All patients were treated with locking plate( LISS system) internal fixation through open reduction. The mobility of knee joint and HSS score were recorded and compared before and after operation. Results Fracture healing was confirmed in all 8 patients,and the average HSS score was 83. 2. One patient suffered from fracture malunion due to loosening of the LISS plate,and legacy constrained condylar knee replacement was performed for reversion. Conclusion LISS plate internal fixation for the treatment of Rorabeck type Ⅱ fracture after TKA can obtain satisfactory results,with less trauma and reliable internal fixation.
Objective To investigate the treatments and outcomes of Rorabeck type Ⅱ periprosthetic distal femur fracture after total knee arthroplasty( TKA). Methods A total of 9 patients( Rorabeck type Ⅱ) who suffered femoral prosthesis fracture after TKA from June 2012 to May 2017 were included,with follow-up of 32. 3 ± 14. 1 months( 12-60). All patients were treated with locking plate( LISS system) internal fixation through open reduction. The mobility of knee joint and HSS score were recorded and compared before and after operation. Results Fracture healing was confirmed in all 8 patients,and the average HSS score was 83. 2. One patient suffered from fracture malunion due to loosening of the LISS plate,and legacy constrained condylar knee replacement was performed for reversion. Conclusion LISS plate internal fixation for the treatment of Rorabeck type Ⅱ fracture after TKA can obtain satisfactory results,with less trauma and reliable internal fixation.
引文
[1]李宇能.膝关节假体周围骨折手术治疗[J].国际骨科学杂志,2014,35(5):289-291.
[2]Sarmah SS,Patel S,Reading G,et al.Periprosthetic fractures around total knee arthroplasty[J].Ann R Coll Surg Engl,2012,94(5):302-307.
[3]周一新,黄德勇,张洪.膝关节假体周围骨折的分型与治疗[J].中华骨科杂志,2003,23(4):248-250.
[4]Rorabeck CH,Angliss RD,Lewis PL.Fractures of the femur,tibia,and patella after total knee arthroplasty:decision making and principles of management[J].Instr Course Lect,1998,47:449-458.
[5]Choy WS,Lee KW,Kim HY,et al.Mobile bearing medial unicompartmental knee arthroplasty in patients whose lifestyles involve high degrees of knee flexion:A 10-14year follow-up study[J].Knee,2017,24(4):829-836.
[6]Tsukada S,Kurosaka K,Maeda T,et al.Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection:a randomized-controlled trial[J].Knee Surg Sports Traumatol Arthrosc,2019,27(4):1124-1131.
[7]Hagel A,Siekmann H,Delank KS.Periprosthetic Femoral Fracture-an Interdisciplinary Challenge[J].Dtsch Arztebl Int,2014,111(39):658-664.
[8]Doo YJ,Ki KN.Periprosthetic Fractures Following Total Knee Arthroplasty[J].Instr Course Lect,2015,27(1):1-9.
[9]沈奕,李晓淼,丁裕润,等.全膝关节置换术后股骨假体周围骨折:附18例报告[J].中国临床医学,2014,21(6):689-691.
[10]Backstein D,Safir O,Gross A.Periprosthetic fractures of the Knee[J].J Arthroplasty,2007,22(4 suppl 1):45-49.
[11]Reeves RA,Schairer WW,Jevsevar DS.Costs and Risk Factors for Hospital Readmission After Periprosthetic Knee Fractures in the United States[J].J Arthroplasty,2018,33(2):324-330.
[12]Rorabeck CH,Taylor JW.Periprosthetic fractures of the femur complicating total knee arthroplasty[J].Orthop Clin North Am,1999,30(2):265-277.
[13]李海航,翁蔚宗,魏显招,等.膝关节置换术后股骨远端骨折治疗的研究进展[J].中国矫形外科杂志,2014,22(2):134-137.
[14]Lesh ML,Schneider DJ,Deol G,et al.The consequences of anterior femoral notching in total knee arthroplasty.A biomechanical study[J].J Bone Joint Surg Am,2000,82-A(8):1096-1101.
[15]Ebraheim NA,Liu J,Hashmi SZ,et al.High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties[J].J Arthroplasty,2012,27(5):809-813.
[16]Hou Z,Bowen TR,Irgit K,et al.Locked plating of periprosthetic femur fractures above total knee arthroplasty[J].J Orthop Trauma,2012,26(7):427-432.
[17]Ristevski B,Nauth A,Williams DS,et al.Systematic review of the treatment of periprosthetic distal femur fractures[J].J Orthop Trauma,2014,28(5):307-312.
[18]Button G,Wolinsky P,Hak D.Failure of Less Invasive Stabilization System Plates in the Distal Femur[J].J Orthop Trauma,2004,18(8):565-570.
[19]Kregor PJ,Stannard JM,Cole PA,et al.Distal femoral fracture fixation utilizing the Less Invasive Stabilization System(L.I.S.S.):the technique and early results[J].Injury,2001,32 Suppl 3:SC32-SC47.
[20]熊建,付中国,张殿英,等.微创内固定稳定系统治疗全膝关节置换术后股骨髁上假体周围骨折[J].北京大学学报:医学版,2011,43(5):714-717.
[21]Althausen PL,Lee MA,Finkemeier CG,et al.Operative stabilization of supracondylar femur fractures above total knee arthroplasty:a comparison of four treatment methods[J].J Arthroplasty,2003,18(7):834-839.
[22]Erhardt JB,Grob K,Roderer G,et al.Treatment of periprosthetic femur fractures with the non-contact bridging plate:a new angular stable implant[J].Arch Orthop Trauma Surg,2008,128(4):409-416.
[2]Sarmah SS,Patel S,Reading G,et al.Periprosthetic fractures around total knee arthroplasty[J].Ann R Coll Surg Engl,2012,94(5):302-307.
[3]周一新,黄德勇,张洪.膝关节假体周围骨折的分型与治疗[J].中华骨科杂志,2003,23(4):248-250.
[4]Rorabeck CH,Angliss RD,Lewis PL.Fractures of the femur,tibia,and patella after total knee arthroplasty:decision making and principles of management[J].Instr Course Lect,1998,47:449-458.
[5]Choy WS,Lee KW,Kim HY,et al.Mobile bearing medial unicompartmental knee arthroplasty in patients whose lifestyles involve high degrees of knee flexion:A 10-14year follow-up study[J].Knee,2017,24(4):829-836.
[6]Tsukada S,Kurosaka K,Maeda T,et al.Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection:a randomized-controlled trial[J].Knee Surg Sports Traumatol Arthrosc,2019,27(4):1124-1131.
[7]Hagel A,Siekmann H,Delank KS.Periprosthetic Femoral Fracture-an Interdisciplinary Challenge[J].Dtsch Arztebl Int,2014,111(39):658-664.
[8]Doo YJ,Ki KN.Periprosthetic Fractures Following Total Knee Arthroplasty[J].Instr Course Lect,2015,27(1):1-9.
[9]沈奕,李晓淼,丁裕润,等.全膝关节置换术后股骨假体周围骨折:附18例报告[J].中国临床医学,2014,21(6):689-691.
[10]Backstein D,Safir O,Gross A.Periprosthetic fractures of the Knee[J].J Arthroplasty,2007,22(4 suppl 1):45-49.
[11]Reeves RA,Schairer WW,Jevsevar DS.Costs and Risk Factors for Hospital Readmission After Periprosthetic Knee Fractures in the United States[J].J Arthroplasty,2018,33(2):324-330.
[12]Rorabeck CH,Taylor JW.Periprosthetic fractures of the femur complicating total knee arthroplasty[J].Orthop Clin North Am,1999,30(2):265-277.
[13]李海航,翁蔚宗,魏显招,等.膝关节置换术后股骨远端骨折治疗的研究进展[J].中国矫形外科杂志,2014,22(2):134-137.
[14]Lesh ML,Schneider DJ,Deol G,et al.The consequences of anterior femoral notching in total knee arthroplasty.A biomechanical study[J].J Bone Joint Surg Am,2000,82-A(8):1096-1101.
[15]Ebraheim NA,Liu J,Hashmi SZ,et al.High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties[J].J Arthroplasty,2012,27(5):809-813.
[16]Hou Z,Bowen TR,Irgit K,et al.Locked plating of periprosthetic femur fractures above total knee arthroplasty[J].J Orthop Trauma,2012,26(7):427-432.
[17]Ristevski B,Nauth A,Williams DS,et al.Systematic review of the treatment of periprosthetic distal femur fractures[J].J Orthop Trauma,2014,28(5):307-312.
[18]Button G,Wolinsky P,Hak D.Failure of Less Invasive Stabilization System Plates in the Distal Femur[J].J Orthop Trauma,2004,18(8):565-570.
[19]Kregor PJ,Stannard JM,Cole PA,et al.Distal femoral fracture fixation utilizing the Less Invasive Stabilization System(L.I.S.S.):the technique and early results[J].Injury,2001,32 Suppl 3:SC32-SC47.
[20]熊建,付中国,张殿英,等.微创内固定稳定系统治疗全膝关节置换术后股骨髁上假体周围骨折[J].北京大学学报:医学版,2011,43(5):714-717.
[21]Althausen PL,Lee MA,Finkemeier CG,et al.Operative stabilization of supracondylar femur fractures above total knee arthroplasty:a comparison of four treatment methods[J].J Arthroplasty,2003,18(7):834-839.
[22]Erhardt JB,Grob K,Roderer G,et al.Treatment of periprosthetic femur fractures with the non-contact bridging plate:a new angular stable implant[J].Arch Orthop Trauma Surg,2008,128(4):409-416.