记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B_1型股骨假体周围骨折

Using Shape Memory Alloy Embracing Fixator and Self-ilium Grafting to Surgically Treat Vancouver Type-B_1 Periprosthetic Femoral Fractures

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 explore a surgical method for treating Vancouver type-B1 periprosthetic femoral fractures after artificial hip replacement surgery.Methods Between April 2006 and February 2011,we treated 6 cases of Vancouver type-B1 periprosthetic femoral fractures with shape memory alloy embracing fixator and self-ilium grafting in our hospital.There were 2 males and 4 females,aged between 55 and 78 years,averaging at 68.5.All six patients underwent artificial hip replacement surgery for the first time.The time between the replacement surgery and the development of periprosthetic femoral fractures ranged from 6 months to 8 years with an average of 18.4 months.And the time between the fractures and surgery for the fractures ranged from 3 to 6 days with an average of 4.2 days.Results All fractures were proved to be healed with no complications such as deep vein thrombosis,lung infection,or lung embolism.All six patients were followed up for 13 months to 4 years,averaging 28.6 months.X ray examination showed that all fractures were healed within 12 to 20 weeks,averaging 14.8 weeks.The Harris score was between 76 and 93,with an average of 83.6,and there were three cases getting an excellent and the other three a good outcome.No bone plate breaking or loosening,fracture re-shifting,bone nonunion,or perioprosthetic femoral loosening occurred.Conclusion Shape memory alloy embracing fixator and self-ilium grafting provide a reliable,simple and practical alternative method for the treatment of Vancouver type-B1 periprosthetic femoral fractures.