髋关节置换术后假体周围骨折手术方式选择及疗效观察

The operation methods and curative effect of periprosthetic fracture after hip replacement

目的探讨不同手术方式的选择对于髋关节置换术后假体周围骨折的疗效。方法以56例髋关节置换术后的假体周围骨折患者为对象,手术方式根据Vancouve分型标准确定,骨折类型参照Vancouver分类标准分为A、B、C 3型(组)并观察术后疗效。结果三组治疗后的疼痛模拟评分(VAS)低于治疗前(t=6.630、10.756、5.738,P=0.000);三组治疗后的Harris评分高于治疗前(t=36.290、57.814、33.164,P=0.000);三组VAS评分、Harris评分差异有统计学意义(F=13.581,P=0.012;F=8.632,P=0.006),A型优于B、C型(P<0.05);三组的手术时间、术中出血量、骨折愈合时间差异具有统计学意义(F=13.186,P=0.011;F=8.0722,P=0.0094;F=9.835,P=0.009);A型短于B、C型(P<0.05或0.01);三组不良反应发生率差异无统计学意义(χ2=1.532,P=0.465)。结论根据假体周围骨折分型及患者体质选择具体的手术治疗方式,能够获得最佳的治疗结果。

Objective To investigate the effect of different operation modes selection for periprosthesis fractures after hip replacement.Methods Totally 56 cases of periprosthetic fractures after hip replacement were selected and divided into three groups according to the Vancouver classification criteria and the efficacy after operation was observed.Results VAS scores of the three groups after treatment were lower than those before therapy （t =6.630,10.756,5.738,P =0.000） while Harris scores of the three groups after treatment were higher than those before treatment（t =36.290,57.814,33.164,P =0.000） ;differences among scores of the three groups had statistical significance in VAS score and Harris score （F =13.581,P =0.012;F =8.632,P =0.006）,type A was better than that of the type B and typeC （P 〈 0.05） ; the operation time,bleeding volume during operation and the healing time of the three groups had statistical significance （F =13.186,P =0.011 ; F =8.0722,P =0.0094 ; F =9.835,P =0.009） ; type A needed less time than type B and typeC （P 〈 0.05 or 0.01） ; the adverse reaction rates had no significant difference （χ^2 =1.532,P =0.465）.Conclusion Selecting the operation mode according to the specificity of periprosthetic fracture type and the patients can obtain the best treatment outcome.