股骨环抱器记忆合金治疗Vancouver B1型股骨假体周围骨折的临床效果

Clinical effect of femoral memory alloy embracing fixator in treatment of vancouver B1 periprosthetic femoral fracture

目的研究股骨环抱器记忆合金治疗髋关节置换术后Vancouver B1型股骨假体周围骨折的临床效果。方法回顾分析自2012年2月至2018年12月在商丘市第一人民医院治疗的20例Vancouver B1型股骨假体周围骨折,男性7例,女性13例,年龄48~83岁,平均70.4岁。均为初次髋关节置换术后假体周围骨折,初次置换原因,股骨头坏死3例,髋关节炎2例,股骨颈骨折13例,股骨转子间骨折2例。其中全髋关节置换11例,半髋关节置换9例。股骨假体4例为骨水泥型,16例为生物型。均为Vancouver B1型。致伤原因:摔伤17例;交通伤3例。骨折发生时间为髋关节置换术后3~120个月,平均49个月。均采用切开复位股骨环抱器记忆合金内固定治疗。术后随访12~72个月,平均24个月。观察指标包括手术时间,术中出血量,患侧髋关节Harris功能评分,负重行走时骨折部位疼痛情况,X线上观察骨折是否骨性愈合,术后并发症发生情况。结果所有患者均得到随访,本组患者的手术时间平均为50 min(45~70 min),术中出血量平均为220 mL(160~400 mL)。20例患者末次随访时间为术后12~72个月,平均24个月。末次随访时髋关节Harris评分75~92分,平均85.4分,评定疗效:优12例,良7例,可1例,优良率为95%。负重行走时骨折部位疼痛VAS评分0~2分,平均0.8分。所有患者术后均获骨性愈合,愈合时间平均为16周(12~24周)。术后无局部感染、下肢深静脉血栓形成、神经损伤等并发症发生。结论股骨环抱器记忆合金具是治疗Vancouver B1型股骨假体周围骨折良好的内固定材料,具有容易安置,有助复位,固定牢固,效果优良的特点。

Objective To investigate the clinical effect of femoral memory alloy embracing fixator in the treatment of Vancouver type B1 periprosthetic femoral fracture following hip arthroplasty.Methods Retrospective analysis was performed on 20 cases of Vancouver type B1 periprosthetic femoral fracture treated at Shangqiu First People’s Hospital from February 2012 to December 2018.There were 7 males and 13 females,aged 48~83 years,with an average age of 70.4 years.All of them were periprosthesis fractures after primary hip replacement.The causes of primary replacement included femoral head necrosis in 3 cases,hip arthritis in 2 cases,femoral neck fracture in 13 cases and intertrochanteric fracture in 2 cases.Total hip arthroplasty was performed in 11 patients and half hip arthroplasty in 9 patients.4 cases of femur prosthesis were bone cement type and 16 were biotype.All are of type Vancouver B1.Cause of injury:17 cases of fall;Traffic injuries in 3 cases.The fracture occurred 3~120 months after hip replacement,with an average of 49 months.All cases were treated with open reduction and internal fixation with femoral memory alloy embracing fixator.Postoperative follow-up was 12~72 months,with an average of 24 months.Results All patients were followed up.In this group,the average operative time was 50 min(45~70 min),and the average intraoperative blood loss was 220 mL(160~400 mL).The last follow-up time of 20 patients was 12~72 months postoperatively,with an average of 24 months.At the last follow-up,Harris score of hip joint was 75~92 points,with an average of 85.4 points.The evaluation of curative effect was as follows:12 cases were excellent,7 cases were good,and 1 case was fair,with an excellent and good rate of 95%.VAS score of fracture site pain during weight-bearing walking was 0~2 points,with an average score of 0.8 points.Postoperative osseous healing was achieved in all patients,and the average healing time was 16 weeks(12~24 weeks).No complications such as local infection,deep venous thrombosis of lower extremities and nerve injury occurred.Conclusion Femoral ring memory alloy is a good internal fixation material for the treatment of Vancouver B1 periprosthetic femoral fracture.