组配型长柄假体在不稳定股骨假体周围骨折中的应用

Unstable femoral periprosthetic fractures treated with a modular long-stem prosthesis

背景：目前对于不稳定股骨假体周围骨折,尤其是伴有严重骨缺损的病例尚无统一治疗方法。目的：探讨组配型长柄假体在治疗不稳定股骨假体周围骨折中的作用和效果。方法：采用组配型长柄假体治疗不稳定股骨假体周围骨折患者25例,采用Harris髋关节评分评价髋关节功能,通过X线片评价骨折愈合、假体稳定性和骨缺损修复情况。结果：25例全部获得随访,平均随访（44.0±16.2）个月（12-84个月）。Harris评分由术前平均（22.3±6.2）分（7-31分）提高到末次随访时的（85.2±5.0）分（70-91分）（P〈0.01）。骨折全部愈合,无假体松动断裂,术后出现脱位和感染各1例。结论：采用组配型长柄假体治疗不稳定股骨假体周围骨折的操作相对简便、手术效果良好、并发症少,是一种较好的选择。

Background： There is no unified treatment for unstable femoral periprosthetic fractures at present, especially those with severe bone defects.Objective： To evaluate the effect of modular long-stem prosthesis in treating unstable femoral periprosthetic fractures.Methods： Twenty- five consecutive patients with unstable femoral periprosthetic fractures were treated by using a modular long-stem prosthesis. The joint function was assessed by Harris hip score（HHS）. The fracture healing, prosthetic loosening and bone defect repair were evaluated by X-rays.Results： The mean duration of follow-up was（44.0±16.2） months（range, 12-84 months） in all the patients. The mean preoperative HHS was 22.3±6.2（range, 7-31）, which was significantly lower than that at the last follow-up（85.2±5.0, ranging, 70-91, P〈0.01）. All fractures were healed. No prosthetic loosening or refracture occurred. There was one hip dislocation and one periprosthetic infection after surgery.Conclusions： The modular long-stem prosthesis is a very good clinical option in treating unstable femoral periprosthetic fractures for convenient operation, satisfactory outcomes and low complication rate.