髋关节置换术后Vancouver B1股骨假体周围骨折临床治疗分析

Analysis of Vancouver B1 femoral prosthetic fractures after hip replacement

目的:探究分析远端经皮微创钢板接骨术(Minimally Invasive Plate Osteosynthesis,MIPO)技术联合带大粗隆结合装置钛缆钢板治疗髋关节置换术后Vancouver B1股骨假体周围骨折临床疗效。方法:回顾性分析2017年4月-2019年4月手术治疗的17例髋关节置换术后股骨假体周围骨折患者分型均为Vancouver B1型,采用统一手术方案及中西医结合治疗措施,术后根据骨折愈合情况及髋关节功能Harris评分进行疗效评估。结果:17例患者均得到回访,回访时间为9~24个月,平均(14.53±5.51)个月。患者术中手术时长80~150 min,平均时长为(106.18±19.08)min,刀口长度为10~14 cm,平均长度为(11.53±1.33)cm;回访患者6个月内骨折均愈合,平均愈合时间为(123.35±19.66)d。手术后末次随访髋关节Harris评分为66~94分,平均为(83.29±8.55)分,其中髋关节活动评分优6例,良7例,可2例,差2例。末次回访未出现假体及固定物松动、感染等并发症。结论:采取远端MIPO联合带大粗隆结合装置钛缆钢板治疗Vancouver B1股骨假体周围骨折可取的良好疗效;采用中西医结合治疗股骨假体周围骨折可取的良好疗效;髋关节置换术后及股骨假体周围骨折术后应明确危险因素,制定个性化治疗方案,采取中西医结合行抗骨质疏松治疗可取的良好疗效。

Objective:To explore and analyze the clinical effect of distal MIPO technique combined with a large tuberosity combined device titanium cable plate in the treatment of Vancouver B1 femoral prosthetic fractures after hip arthroplasty.Methods:A retrospective analysis of 17 patients with femoral prosthetic fractures after hip replacement surgery from April 2017 to April 2019.The classifications are all Vancouver B1,adopt a unified surgical plan and integrated the integrative medicine treatment measures,and evaluate the curative effect based on the fracture healing and the Harris score of hip joint function after surgery.Results:All 17 patients received a return visit.The return visit time was 9~24 months,with an average of(14.53±5.51)months.The patient’s intraoperative operation time was 80~150 min,the average time was(106.18±19.08)min,the incision length was 10~14 cm,and the average length was(11.53±1.33)cm.All fractures healed within 6 months of the follow-up visit,and the average healed The time is(123.35±19.66)days.The Harris score of the hip joint at the last follow-up after the operation was 66~94 points,with an average of(83.29±8.55)points.Among them,the hip joint activity score was excellent in 6 cases,good in 7 cases,2 cases were fair,and 2 cases were poor.There were no complications such as loosening of prosthesis and fixation and infection during the last return visit.Conclusion:The treatment of Vancouver B1 peripheral femoral prosthesis fractures with the distal MIPO technique combined with the titanium cable plate with a large tuberosity combined device showed curative effect.The combination of the integrative medicine is effective on femoral prosthetic fractures.After hip arthroplasty and after the operation of the fracture around the femoral prosthesis,the risk factors should be clarified,and the personalized treatment plan should be formulated.The combination of the integrative medicine for anti-osteoporosis treatment has a good effect.