索绑系统治疗不同类型股骨假体周围骨折

Application of Cable-Ready system in treatment of periprosthetic femoral fractures of different prostheses

目的分析Cable-Ready索绑系统应用于不同类型股骨假体的全髋关节置换术(THA)后的股骨假体周围骨折临床效果。方法回顾性分析2010年在新疆维吾尔自治区中医医院行手术治疗的THA术后股骨假体周围骨折的79例患者,根据初次THA所使用的股骨假体类型,分为生物型假体组(47例)、骨水泥假体组(32例)。t检验或秩和检验、卡方检验比较两组的手术时间、术中出血量、住院时间、骨折临床愈合时间,髋关节功能评分量表Harris评分及并发症。结果两组患者的性别(χ^2=0.855)、年龄(t=-1.132)、股骨假体周围骨折的温哥华分型(χ^2=0.349)、住院时间(t=-0.872)、骨折愈合时间(t=-1.336)等比较,差异无统计学意义(均为P>0.05);生物型假体组的手术时间(t=-5.860)、术中出血量(t=-50.128)比骨水泥假体组少(P<0.05)。两组患者发生股骨假体周围骨折前的髋关节Harris疼痛评分(t=-1.897)、功能评分(t=1.757)比较差异无统计学意义(均为P>0.05)。术后1年评估Harris评分,疼痛情况(Z=-1.157)、功能情况(Z=-0.540)与受伤前比较,评分变化的差异无统计学意义(均为P>0.05),两组患者术后1年的Harris畸形评分(t=-0.858)、关节活动度评分(t=-1.231)差异无统计学意义(均为P>0.05)。随访期间生物型假体组出现共计7例并发症;骨水泥型假体组出现共计6例并发症,两组的并发症情况差异无统计学意义(χ^2=0.206,P>0.05)。结论Cable-Ready索绑系统应用于生物型假体和骨水泥型假体的股骨假体周围骨折的住院时间、骨折愈合时间、髋关节功能恢复情况基本一致,但应用生物型假体的患者可节约手术时间、减少出血量。

Objective To analyze the clinical outcomes of periprosthetic femoral fracture after total hip arthroplasty(THA)with the application of Cable Ready system to different types of femoral prostheses.Methods A total of 79 patients with periprosthetic femoral fractures following THA who were treated surgically with Cable-Ready system in Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from 2010 to 2019,were retrospectively divided into the biotype prosthesis group(47 patients)and the cemented prosthesis group(32 patients)according to the prosthesis type in primary THA.The operation time,intraoperative blood loss,length of hospital stay,clinical healing of fractures,Harris score,and complications were compared between the two groups using t test,Mann-Whitney U test,or Chi-square test.Results There was no statistically significant difference in gender(χ^2=0.855),age(t=-1.132),Vancouver classification(χ^2=0.349),length of hospital stay(t=-0.872),or time to fracture healing(t=-1.336)between the two groups(all P>0.05).The duration of surgery(t=-5.860)and intraoperative blood loss(t=-50.128)were less in the biotype prosthesis group than those in the cemented prosthesis group(both P<0.05).The Harris pain scores(t=-1.897)and functional scores(t=1.757)before periprosthetic femoral fracture were compared between the two groups and there was no statistically significant difference(all P>0.05).One year after the operation,the changes of pain(Z=-1.157)and function condition(Z=-0.540)were compared between the two groups,and the differences were not statistically significant(both P>0.05),while the Harris deformity score(t=-0.858)and joint mobility score(t=-1.231)were basically consistent between the two groups at one year after the operation(both P>0.05).A total of seven complications occurred in the group with biotype prostheses during follow-up and six in the group with cemented prostheses,and the occurrence of complications in the two groups was almost the same(χ^2=0.206,P>0.05).Conclusion When femoral periprosthetic fractures treated by Cable Ready system,the length of hospital stay,fracture healing time,and recovery of hip function are generally consistent in both the biotype and cemented prostheses,but the patients of biotype prosthesis for primary THA have shorter operation time and less blood loss.