全膝关节置换术后KimⅠB型股骨侧假体周围骨折的手术治疗

Surgical management in treating periprosthetic femoral fractures after total knee arthroplasty

目的探讨膝关节表面置换术后股骨假体周围骨折的手术方法及临床疗效。方法回顾性分析2015年7月至2019年7月采用手术治疗的9例股骨假体周围骨折患者,女性8例,男性1例,年龄65~92岁,平均(75.3±8.7)岁。所有病例均为初次膝关节表面置换术后,假体为骨水泥型。Kim分型均为ⅠB型。骨折发生时间为术后3个月至14年,平均(6.1±3.9)年。依据骨折特点,采用钢板或髓内钉内固定。随访时记录膝关节活动度、关节功能及骨折部位疼痛视觉模拟评分(visual analogue scale,VAS),通过骨折部位的疼痛情况及X线片来判断骨折是否愈合。结果所有病例均获得随访,时间为12~36个月,平均(28±8.5)个月。8例患者骨折部位负重VAS评分为0分,达到临床愈合;1例术后骨折未愈合。骨折临床愈合率88.9%(8/9)。末次随访时HSS评分20~90分,平均(74.0±19.6)分;除1例骨折不愈合外,无其它并发症。结论针对不同股骨假体周围骨折的特点,制定相应的手术方案,结合早期功能锻炼,可取得较好的临床效果。

Objective To observe the clinical effects of the surgical management of periprosthetic femoral fractures following total knee arthroplasty.Methods Nine consecutive patients(8 females and 1 male)with the average age of(75.3±8.7)years old(65 to 92 years old)undergoing surgical operation for periprosthetic femoral supracondylar fractures between July 2015 and July 2019 were followed up at our department.All patients were fractured secondary to the primary knee arthroplasty.The fixation of femoral components were all cemented fixation.They were determined as Kim type IB.The occurrences of the fractures were observed at 3 month to 14 years post-operation[average(6.1±3.9)years].The patientswere treated individually according to different charecteristics with locking plate or intramedullary nail.The following-up included the motion range,the HSS knee score and the visual analogue scale(VAS)for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture site.Re sults All cases were followed up with a time range 12-36 months[average(28±8.5)months],the VAS scores of 8 cases were 0,reached clinical healing,1 case showed nonunion of the fracture,the fracture union rate was88.9%(8/9),the VAS score was 74.0±19.6.Post-operative complication were observed in 1 patient who suffered from nonunion of the fracture.Conclusion According to the characteristics of the fractures around the femoral prosthesis,the corresponding surgical programs were developed and combined with early functional exercise,which can achieve better clinical result.