| 髋关节置换术后股骨假体周围骨折手术治疗的疗效分析 |
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投稿时间：2020-06-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 周金华 |
ZHOUJin-hua |
湖南师范大学附属第一医院湖南省人民医院创伤骨病科, 湖南长沙 410000 |
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China |
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| 王愉思 |
WANG Yu-si |
湖南师范大学附属第一医院湖南省人民医院创伤骨病科, 湖南长沙 410000 |
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China |
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| 盛斌 |
SHENG Bin |
湖南师范大学附属第一医院湖南省人民医院创伤骨病科, 湖南长沙 410000 |
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China |
shengbin2009@163.com |
| 李新 |
LI Xin |
湖南师范大学附属第一医院湖南省人民医院创伤骨病科, 湖南长沙 410000 |
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China |
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| 关蕊 |
GUAN Rui |
湖南师范大学附属第一医院湖南省人民医院创伤骨病科, 湖南长沙 410000 |
Orthopaedic Traumatology Department, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410000, Hunan, China |
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| 期刊信息：《中国骨伤》2021年，第34卷，第3期，第255-259页 |
| DOI：10.12200/j.issn.1003-0034.2021.03.013 |
| 基金项目:湖南省自然科学基金（编号：2019JJ40163） |
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中文摘要:
目的：分析比较人工髋关节置换术（hip arthroplasty，HA）后股骨假体周围骨折（periprosthetic femur fracture，PFF）不同分型手术治疗的临床疗效。
方法：回顾性分析自2010年9月至2016年9月因人工髋关节置换术后假体周围骨折入院的手术患者47例（共47髋），其中男13例，女34例；依据Vancouver分型，AG型2例，B1型17例，B2型19例，B3型7例，C型2例；年龄56~94（71.5±8.3）岁。入院后采用营养风险筛查（NRS2002）评估患者营养状况，18例（38%）患者存在营养不良风险（NRS>3分），患者入院后依据不同分型予相应手术治疗，记录术中出血量，应用Harris评分评价患髋关节功能，入院及术后进行视觉模拟评分（visual analogue scale，VAS）评分。
结果：47例患者均顺利完成手术，随访19~62（34±11）个月，术前及术后1年随访时的Harris评分分别为（41.8±12.1）分、（89.0±2.6）分，两组间比较差异有统计学意义（t=29.7，P<0.01）；术前及术后1年随访时的VAS评分分别为（8.0±0.6）分、（0.5±0.6）分，两组间比较差异有统计学意义（t=80.7，P<0.01）；B1型营养不良风险患者及无营养不良风险患者术中出血量分别为（730±68） ml、（688±127） ml，两者比较差异有统计学意义（t=4.6，P<0.05）； B2型营养不良风险患者及无营养不良风险患者术中出血量分别为（916±118） ml、（884±88） ml，两者比较差异有统计学意义（t=8.7，P<0.05）。末次随访时所有患者骨折均愈合，下肢力线良好，随访期间未发生内固定松动、移位、断裂及假体松动、脱位等情况。
结论：治疗髋关节假体周围骨折患者应依据患者的一般情况、影像学资料、术中校正分型等制定符合患者的个体化治疗方案，对于术前有营养不良风险的患者，在术前进行营养学的干预或能减少术中出血。 |
| 【关键词】关节成形术,置换,髋 假体周围骨折 外科手术 |
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| Analysis of the effect of surgical treatment of periprosthetic femoral fractures after hip replacement |
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ABSTRACT
Objective: To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA).
Methods: From September 2010 to September 2016,47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed,including 13 males and 34 females. According to Vancouver classification,there were 2 patients with type AG,17 patients with type B1,19 patients with type B2,7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission,nutritional risk screening (NRS2002) was used to assess the nutritional status of the patients. Eighteen patients(38%) had malnutrition risk (NRS>3 points). After admission,the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation.
Results: All the 47 patients were followed up for 19 to 62(34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation,and the difference was statistically significant (t=29.7,P<0.01). The VAS pain scores were (8.0±0.6) and (0.5±0.6) respectively before and 1 year after operation,and the difference was statistically significant(t=80.7,P<0.01). The intraoperative blood loss was (730±68) ml and (688±127) ml in patients with type B1 malnutrition risk and patients without malnutrition risk,and the difference was statistically significant (t=4.6,P<0.05);the intraoperative blood loss was (916±118) ml and (884±88) ml in patients with type B2 malnutrition risk and patients without malnutrition risk,and the difference was statistically significant(t=8.7,P<0.05). At the last follow-up,all the fractures were healed and the force line of lower limbs was good. No loosening,displacement,fracture of internal fixation,loosening and dislocation of prosthesis occurred during the follow-up period.
Conclusion: The treatment of hip periprosthetic fracture patients should be based on the general situation of patients,imaging data,intraoperative correction classification,etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk,preoperative nutritional intervention may reduce intraoperative bleeding. |
| KEY WORDS Arthroplasty,replacement,hip Periprosthetic fracture Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 周金华,王愉思,盛斌,李新,关蕊.髋关节置换术后股骨假体周围骨折手术治疗的疗效分析[J].中国骨伤,2021,34(3):255~259 |
| 英文格式: | ZHOUJin-hua,WANG Yu-si,SHENG Bin,LI Xin,GUAN Rui.Analysis of the effect of surgical treatment of periprosthetic femoral fractures after hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(3):255~259 |
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