导致全髋关节置换术中髋臼假体周围骨折的因素及治疗方法探讨

Study on the Causes and Treatment of Acetabular Periprosthetic Fracture of Total Hip Arthroplasty

目的分析导致全髋关节置换术(THA)中髋臼假体周围骨折(APF)的因素及其治疗方法。方法选择上蔡县协和医院2013年2月-2018年2月收治的THA患者380例进行研究,纳入对象有完整临床资料,回顾性分析资料,根据有无APF分为观察组(出现APF,n=18例)与对照组(未出现APF,n=362例)。对两组患者相关资料进行总结、分析及比较,总结导致术中APF的因素,并制定有效的治疗方法处理。结果两组患者在性别、年龄、体质量指数、手术入路上比较无显著差异(P>0.05),但组间原发性疾病、有无骨质疏松、假体类型、假体覆盖率上对比差异显著(P<0.05);经多因素Logistic回归分析,原发疾病、骨质疏松、假体类型、假体覆盖率是术中APF危险因素;经过治疗后,随访1年显示18例APF均骨性愈合。结论THA术中所致APF的因素较多,主要和原发病类型、有骨质疏松、假体类型、假体覆盖率等有关,为此在开展THA时应重点注意这些因素,避免发生APF。

Objective To analyze the cause leading to acetabular prosthesis fracture(APF)in total hip replacement(THA)and its treatment.Methods A total of 380 THA patients who had complete clinical data in the Union Hospital of Shangcai county from February 2013 to February 2018 were enrolled as the study objects.and all of those data were retrospectively analyzed.According to the presence and absence of APF,these patients were divided into the observation group(with APF,n=18)and the control group(without APF,n=362).The relevant data of the two groups of patients were summarized,analyzed and compared to summarize the cause leading to APF during operation and develop effective treatment.Results There was no significant difference between the two groups in gender,age,BMI and surgical approach(P>0.05),however,there were significant differences between the two groups in primary disease,osteoporosis,prosthesis type and coverage rate of prosthesis(P<0.05).Multivariate logistic regression analysis showed that primary disease,osteoporosis,type of prosthesis and coverage rate of prosthesis were risk factors for APF during operation.1 year follow-up after treatment showed bone healing in all 18 cases of APF.Conclusion There are many factors causing APF in THA,mainly related to the primary type of disease,osteoporosis,type of prosthesis,coverage rate of prosthesis,etc.Therefore,attention should be paid to these factors when THA is carried out to avoid the occurrence of APF.