【摘要】 目的 探讨人工髋关节置换术后股骨假体周围骨折的治疗方法及疗效。 方法 回顾分析2001年3月-2009年3月11例股骨假体周围骨折，均为人工股骨柄周围骨折，Vancouver B1型假体无明显松动，均行切开复位，用形状记忆合金环抱器内固定并取髂骨或人工骨植骨治疗。术后随访9~25个月，平均13个月。 结果 术后3~6个月，11例骨折均愈合，平均愈合时间4.5个月。患者无感染、假体松动脱位、内固定断裂和深静脉血栓形成。根据HARRIS髋关节功能评估法估分:优6例，良4例，可1例。 结论 形状记忆合金环抱器不损害假体周围骨皮质及假体或其骨水泥层，操作简便，是治疗人工髋关节置换术后股骨假体周围骨折的较理想的一种方法。【Abstract】 Objective To investigate the therapeutic method and effect of periprosthetic femur fracture after hip arthroplasty. Methods Eleven patients with fracture around the prosthetic femoral stem were included. Prostheses of Vancouver B1 were fixed tightly. All patients accepted reposition enchevillement, intracontention with shape memory alloy encircled fixer, and bone grafting with autologous ilium or artificial bones. The follow-up was nine to 25 months,with the average 13 months. Results All the fracures healed in three to six months after treatment,the average healing time was 4.5 months. There was no infection, loosing or dislocatin of prosthesis. Cracking of internal fixation and thrombosis of deep venouses did not occured either. The excellent healing rate was 10/11 according to Harris hip score. Conclusion Intracontention with shape memory alloy encircled fixer is a good method to fix the fracture around the femur prosthesis, which is easy to manifacture and does no harm to bone cortex around the prosthesis, along with the prosthesis itself and the bone cement layer.
目的 探讨人工髋关节置换术后Vancouver B1型股骨假体周围骨折的治疗方法。 方法 2006年4月－2011年2月采用记忆合金抓握式接骨板固定结合自体髂骨植骨治疗6例Vancouver B1型股骨假体周围骨折。其中男2例，女4例；年龄55～78岁，平均68.5岁。6例均为初次行人工关节置换术后6个月～3年，平均18.4个月发生假体周围骨折；骨折至手术时间为3～6 d，平均4.2 d。 结果 术后切口均Ⅰ期愈合，无深静脉血栓形成、肺部感染、肺栓塞等并发症发生。6例均获随访，随访时间13个月～4年，平均28.6个月。X线片示骨折全部愈合，愈合时间12～20周，平均14.8周。末次随访时Harris评分76～93分，平均83.6分；获优3例，良3例。无1例出现接骨板折断、松动，骨折再移位、骨不连、股骨假体松动等并发症。 结论 记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B1型股骨假体周围骨折具有固定可靠、操作简便的特点，可获满意临床疗效。
Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients (35 hips) underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years (range, 47-79 years). The time from hip arthroplaty to revision was 1-15 years (mean, 9.7 years). The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture (Vancouver type B3) in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon (AAOS), 6 cases were classified as type I, 9 cases as type II, and 20 cases as type III; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm (mean, 49.6 mm), and the revision cups had an outside diameter of 56-68 mm (mean, 60.4 mm). Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years (mean, 8.4 years). The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4 ± 3.6 at last follow-up (t=18.76, P=0.00). The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones (P lt; 0.05). Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in the other patients. Conclusion Jumbo cementless cup for acetabular revision can achieve good effectiveness for having the advantages of simple operation, less bone grafts, and good recovery of the acetabular rotation centre.
Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
Objective To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty. Methods The clinical data of 30 patients (30 hips) with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively. Among them, 15 cases were treated with shape memory alloy embracing device for fracture fixation (group A) and 15 cases with titanium cable cerclage (group B). There was no significant difference in general data such as gender, age, body mass index, the cause of primary arthroplasty and surgical method, prosthesis type, the cause and side of femoral fracture, the time from injury to operation, and comorbidities between the two groups (P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The fracture healing was examined by X-ray film, and the hip joint function was evaluated by Harris score. Results The operations in both groups were completed successfully, and the incisions healed by first intention after operation with no vascular or nerve injury. The operation time and hospital stay in group A were significantly shorter than those in group B (P<0.05), but there was no significant difference in intraoperative blood loss between group A and group B (t=−0.518, P=0.609). Patients were followed up 12-20 months (mean, 16.3 months) in group A and 12-22 months (mean, 16.7 months) in group B. X-ray film showed that all fractures healed, the healing time was (14.73±2.05) weeks in group A and (17.27±2.60) weeks in group B, and there was a significant difference between the two groups (t=−2.960, P=0.006). During follow-up, there was no complication such as prosthesis loosening, periprosthetic infection, joint stiffness, or internal fixator loosening. The Harris score of group A was significantly better than that of group B at 3, 6, and 12 months after operation (P<0.05). Conclusion Compared with titanium cable cerclage, using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing, shorten operation time, and reduce intraoperative blood loss. Patients can perform functional exercise earlier and restore joint function better.
Objective To evaluate the mid-term effectiveness of cerclage wires fixation in treating Mallory typeⅡperiprosthetic femoral fractures associated with primary hip arthroplasty. Methods A retrospective analysis was made in the data of 14 patients (14 hips) with Mallory typeⅡ periprosthetic femoral fractures associated with primary hip arthroplasty and treated with cerclage wires fixation between January 2010 and June 2011 (fracture group). Twenty-eight patients (28 hips) without periprosthetic femoral fractures associated with primary hip arthroplasty at the same stage were chosen as control group. The uncemented femoral prosthesis were used in 2 groups. There was no significant difference in gender, age, body mass index, and primary disease between 2 groups (P>0.05). The operation time, intraoperative blood loss, and the complications were recorded. The Harris score was used to evaluate the hip function and the visual analogue scale (VAS) score was used to evaluate the pain degree of hip. According to the postoperative X-ray films of hips, Enghet al. standard was used to evaluate the fixed and stable status of the femoral prosthesis; the heterotopic ossification was observed; the time of fracture union was recorded. Results The operation time of fracture group was significantly longer than that of control group (t=–3.590, P=0.001). There was no significant difference in the intraoperative blood loss between 2 groups (t=–1.276, P=0.209). All patients were followed up 64-75 months (mean, 69.5 months). Hip dislocation after operation occurred in 1 case of fracture group; delirium symptom and nonunion of incision occurred in 1 case and 1 case of control group, respectively. There was no significant difference in the Harris score and VAS score at 6 months and 5 years between 2 groups (P>0.05). X-ray films showed that all fractures healed and the mean time of fracture union were 6.1 months (range, 3-12 months). There was no fracture nonunion or malunion evidently. There was no significant difference in X-ray score at 6 months and 5 years between 2 groups (P>0.05). At last follow-up, cerclage wires displacement or breakage did not occur. Heterotopic ossification occurred in 2 cases of fracture group and in 1 case of control group. Conclusion Cerclage wires fixation can achieve the good mid-term effectiveness in treating Mallory typeⅡintraoprative periprosthetic femoral fractures associated with primary hip arthroplasty.
Objective To introduce a method for fixation in periprosthetic fracture with locking compression plate (LCP). Methods Duringthe surgery, a long 12-hole LCP was placed to the lateral side of the femur. Six holes of the plate were placed proximal to the main fracture line to make sure that there could be enough cortex units for rigid fixation of proximal fragments. Locking screws used except for the most proximal hole where a 4.5 mm screw was used instead. Results The patient was pain free at the fracture site one week after the surgery,and was able to walk with a cane 3 months after the surgery. Bone union was evident radiographically 3 months after the surgery. There was no loose signs around the stem. Six months after the surgery, the patient recovered full function without pain. Conclusion In our experience from this case, LCP in treating periprosthetic fracture was easy and less time consuming, more over, extensive periosteal stripping could be avoided. LCP is a good choice in treating some periprosthetic fractures.