形状记忆合金环抱器治疗Vancouver B2型股骨假体周围骨折

Effectiveness of shape memory alloy embracing device in treatment of Vancouver B2 periprosthetic femoral fracture

目的探讨应用形状记忆合金环抱器治疗初次人工髋关节置换术后Vancouver B2型股骨假体周围骨折的疗效。方法回顾分析2019年1月—2021年1月收治且符合选择标准的30例(30髋)初次人工髋关节置换术后Vancouver B2型股骨假体周围骨折患者的临床资料。其中15例采用形状记忆合金环抱器固定骨折(A组),15例采用钛缆环扎固定骨折(B组)。两组患者性别、年龄、身体质量指数、初次置换原因及术式、假体类型、股骨假体周围骨折原因、骨折侧别、受伤至手术时间以及合并症等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量以及住院时间,X线片复查骨折愈合情况,采用Harris评分评价髋关节功能。结果两组手术均顺利完成;术后切口均Ⅰ期愈合,无血管、神经损伤等并发症发生。A组手术时间及住院时间均较B组缩短,差异有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(t=-0.518,P=0.609)。两组患者均获随访,A组随访时间12~20个月,平均16.3个月;B组随访时间12~22个月,平均16.7个月。X线片复查示骨折均愈合,A组愈合时间为(14.73±2.05)周,B组为(17.27±2.60)周,组间差异有统计学意义(t=-2.960,P=0.006);随访期间均无假体松动、假体周围感染、关节僵硬以及内固定物松动等并发症发生。A组术后3、6、12个月时Harris评分均优于B组,差异有统计学意义(P<0.05)。结论与钛缆环扎固定相比,采用形状记忆合金环抱器固定Vancouver B2型假体周围骨折可缩短手术时间、减少术中出血量并加速骨折愈合,术后患者可以及早进行功能锻炼,关节功能恢复更好。

Objective To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty.Methods The clinical data of 30 patients(30 hips)with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively.Among them,15 cases were treated with shape memory alloy embracing device for fracture fixation(group A)and 15 cases with titanium cable cerclage(group B).There was no significant difference in general data such as gender,age,body mass index,the cause of primary arthroplasty and surgical method,prosthesis type,the cause and side of femoral fracture,the time from injury to operation,and comorbidities between the two groups(P>0.05).The operation time,intraoperative blood loss,and hospital stay of the two groups were recorded.The fracture healing was examined by X-ray film,and the hip joint function was evaluated by Harris score.Results The operations in both groups were completed successfully,and the incisions healed by first intention after operation with no vascular or nerve injury.The operation time and hospital stay in group A were significantly shorter than those in group B(P<0.05),but there was no significant difference in intraoperative blood loss between group A and group B(t=-0.518,P=0.609).Patients were followed up 12-20 months(mean,16.3 months)in group A and 12-22 months(mean,16.7 months)in group B.X-ray film showed that all fractures healed,the healing time was(14.73±2.05)weeks in group A and(17.27±2.60)weeks in group B,and there was a significant difference between the two groups(t=-2.960,P=0.006).During follow-up,there was no complication such as prosthesis loosening,periprosthetic infection,joint stiffness,or internal fixator loosening.The Harris score of group A was significantly better than that of group B at 3,6,and 12 months after operation(P<0.05).Conclusion Compared with titanium cable cerclage,using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing,shorten operation time,and reduce intraoperative blood loss.Patients can perform functional exercise earlier and restore joint function better.