Objective To evaluate the clinical outcomes of periprosthetic femoral fractures (PFF) following hip arthroplasty utilizing locking compression plates (LCP) in regard to tips and tricks on the construction of LCP augmented with locking attachment plate (LAP) and titanium cables (TC).Methods A total of 41 cases of PFF follow hip arthroplasty (THA 3,Hemi-arthroplasty 2) between May 2008 to April 2016 have been retrospectively analyzed.There were 13 males and 28 females with an average age of 70.5±8.6 years,including 11 case of Unified Classification System (UCS) type Ⅳ.3B1.1,21 cases of B2.1 and 9 cases of type C.All were closed fractures caused by simple fall in terms of low-energy injury.Surgical options depended on individual configuration of the fractures with the combination of LCP and LAP or TC.In respect of reduction techniques,minimally invasive plate osteosynthesis (MIPO) was used in 5 cases for type B1.1 and 8 cases for type C,Mini-open in 6 cases for type B1.1 and 1 case for type C.Posterolateral approach with open reduction internal fixation were selected for type B2.1.The patients were followed up periodically.Harris score,Mukundan criteria and complications were recorded.Results Five cases died of the comorbidities (heart failure 3,pulmonary infection 1,multiple organs failure 1) within 1 year postoperatively.The follow-up rate was 78.0％ (32 out of 41 cases) and the average follow-up time was 41 months (ranging 11 to 71 months).No malunion,no reduction lost,no hardware failure,no hip dislocation and revision surgery following PFF care found.All cases showed the signs of fracture healing from 8 to 12 (average 10 weeks) postoperatively except 2 cases of delay union.The postoperative complications shown in 11 cases,including 2 cases of superficial infection of the wound,6 cases of deep vein thrombosis (popliteal vein 2,intramural gastrocnemius vein 4) and 3 cases of the prosthetic loosening.Harris score at the latest follow-up were 91.5±2.1 for group B1.1,77.5±4.2 for group B2.1 and 83.5±3.8 for group C.The LCP lengths were 248.9±24.3 mm,258.6±25.2 mm,280.4±24.0 mm for group B1.1,B2.1 and C respectively.The LCP length of group B1.1 was short than that of group C (P＜0.05).The screw numbers for the proximal fragments were 6.1±1.8,6.5±0.7 and 3.8±0.7 for group B1.1,B2.1 and C respectively.The number of screws used in B1.1 and B2.1 were more than that in C (P＜0.05).The screw numbers for the distal fragments were 3.5±0.5,3.9±0.5 and 5.1±0.8 for group B1.1,B2.1 and C respectively,indicating less screws used in B1.1 and B2.1 than that in C (P＜0.05).The cable numbers were 1.9±1.3,2.5±0.9 and 3.7±0.7 respectively for group B1.1,B2.1 and C (P＜0.05).The LAP used in 2,12 and 6 cases for type B 1.1,B2.1 and C respectively without significant difference statistically (P＞0.05).Conclusion Utilizing LCP for PFF following hip arthroplasty can achieve satisfactory short and mid-term clinical outcomes with the prerequisites of precise and individualized preoperative planning.LCP augmented by LAP and TC is a reliable option with low complication rate.However,type C PFF needs longer plate with more screws at distal fragment and more titanium cables.%目的 探讨锁定加压钢板内固定治疗股骨假体周围骨折的技术要点及临床疗效.方法 回顾性分析2008年5月至2016年4月收治的41例人工髋关节置换(全髋关节置换39例、人工股骨头置换2例)术后股骨假体周围骨折患者的资料,男13例,女28例;年龄56～85岁,平均(70.5±8.6)岁.通用分型系统(Unified Classification System,UCS)Ⅳ.3B1.1型11例,B2.1型21例,C型9例.均为术后低能量跌倒所致的闭合性骨折.5例B1.1型、8例C型采用微创经皮接骨板技术,6例B1.1型、1例C型采用有限切开复位;B2.1型21例采用髋关节后外侧入路假体翻修及骨折固定.内固定为锁定加压钢板加钛缆或锁定附属钢板.术后以Harris髋关节评分评估临床疗效,摄X线片评估骨折愈合及假体稳定性,记录并发症发生情况.结果 3例因心衰、1例因肺感染、1例因多器官功能衰竭于术后1年内死亡,失访4例,随访率78.0％(32/41).随访时间11～71个月,平均41个月.无畸形愈合、复位丢失、固定失效、假体脱位及再次翻修病例.2例延迟愈合,其余均于8～12周(平均10周)出现骨折愈合征象.术后11例(26.8％,11/41)出现并发症,包括切口浅表感染2例(4.9％,2/41)、腘静脉或小腿肌间静脉血栓形成6例(14.6％,6/41)、假体松动3例(7.3％,3/41).末次随访Harris髋关节评分:B1.1型(91.2±2.1)分,B2.1型(77.5±4.2)分,C型(83.5±3.8)分.锁定加压钢板长度:B1.1型(248.90±24.3) mm,B2.1型(258.6±25.2) mm,C型(280.4±24.0) mm;B1.1型钢板较C型短,差异有统计学意义(P＜ 0.05).骨折近端螺钉数量:B1.1型(6.1±1.8)枚,B2.1型(6.5±0.7)枚,C型(3.8±0.7)枚;B1.1、B2.1型数量均大于C型,差异有统计学意义(P＜0.05).骨折远端螺钉数量:B1.1型(3.5±0.5)枚,B2.1型(3.9±0.5)枚,C型(5.1±0.8)枚;B1.1与B2.1型数量小于C型,差异有统计学意义(P＜0.05).钛缆数量:B1.1型(1.9±1.3)根,B2.1型(2.5±0.9)根,C型(3.7±0.7)根;C型数量大于B1.1与B2.1型,差异有统计学意义(P＜0.05).B1.1、B2.1、C型三组加用锁定附属钢板的病例分别为2例、12例、6例.结论 在制定详细、周密及个性化的术前计划的基础上,采用锁定加压钢板内固定治疗股骨假体周围骨折可获得满意的近中期疗效.辅以锁定附属钢板与钛缆固定可靠,并发症发生率低.C型股骨假体周围骨折内固定需较长的钢板、较多的钛缆及远端螺钉.
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