骨水泥长柄假体翻修术和记忆合金环抱器固定治疗B2型假体周围骨折的临床效果

Clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures

目的 探讨骨水泥长柄假体翻修术和记忆合金环抱器固定治疗B2型假体周围骨折的临床疗效.方法 选取我院2014年4月至2016年4月的102例B2型假体周围骨折患者进行研究,随机分为骨水泥长柄假体翻修术（A组）和骨水泥长柄假体翻修术联合记忆合金环抱器固定术（B组）各51例,按照Beals和Tower 标准评价临床疗效,采用Harris评分评估髋关节功能,采用视觉模拟评分法（VAS） 评分对疼痛进行评价,随访40个月,观察两组患者的临床疗效、骨折愈合时间、并发症及Harris评分和VAS评分.结果 B组的优良率明显高于A组差异有统计学意义（90.2%与72.5%,χ^2=5.239, P〈0.05）;B组的骨折愈合时间、Harris评分、VAS评分与A组比较差异均有统计学意义[（10.2±2.5）周与（21.3±8.9）周、（89.9±13.5）分与（71.2±18.9）分、（1.23±0.25）分与（5.98±1.08）分;t值分别为8.575、5.750、30.600,P均〈0.05）;两组患者均没有发生感染、骨不愈合、复位丢失、内固定松动等并发症.结论 骨水泥长柄假体翻修术联合记忆合金环抱器固定为骨折愈合提供较好的初始稳定性,有利于骨折愈合,是治疗B2型股骨假体周围骨折的理想方法.

Objective To study the clinical effect of cemented long stem prosthesis and memory alloy embracing fixator in the treatment of type B2 periprosthetic fractures.Methods Fom April 2014 to April 2016,102 cases of peripheral B2 periprosthetic fractures patients were selected and randomly divided into bone cement long stem prosthesis revision surgery（group A） and revision of cemented long stem prosthesis combined with memory alloy embracing fixator（group B）,each group with 51 cases.Clinical efficacy was evaluated according to Beals and Tower criteria,used Harris score to evaluate the hip the joint function,used the Visual Analogue Scale（VAS） score to evaluate the pain,after follow-up of 40 months,the clinical curative effect of 2 groups of patients,fracture healing time,complications and Harris score and VAS score were observed.Results The excellent rate of B group was significantly higher than that of A group,with statistical significance（90.2% vs.72.5%,χ^2=5.239,P〈0.05）.Fracture healing time of group B was shorter than that of group A,with statistically significant （（10.2±2.5） weeks vs.（21.3±8.9） weeks,t=8.575,P〈0.05）.Harris the score of group B was higher than the group A,with statistically significant（（89.9±13.5） points vs.（71.2±18.9） points,t=5.750,P〈0.05）.VAS score of group B was significantly lower than the group A,with statistically significant（（1.23±0.25） points vs.（5.98±1.08） points,t=30.600,P〈0.05）.There were no complications such as infection,nonunion,loss of reduction and loosening of internal fixation in the 2 groups.Conclusion Revision of cemented long stem prosthesis combined with memory alloy embracing fixator is an ideal methods for the treatment of type B2 periprosthetic femoral fractures,which provides a good initial stability for fracture healing.