人工髋关节置换术后股骨假体周围骨折的分类及治疗

摘要

目的 探讨人工髋关节置换术后股骨假体周围骨折(periprosthetic femoral fracture,PFF)的分类方法及治疗策略.方法 选择2006年11月-2013年10月人工髋关节置换术后PFF患者22例(22髋),其中男13例,女9例;年龄51～91岁,平均76.8岁.按照改良Vancouver分类:TG型1例,A1型1例,B1型6例,B2型10例,B3型1例,C型3例.采取非手术治疗2例,手术治疗20例,其中9例行内固定,11例行股骨长柄假体翻修.末次随访时采用Harris评分行临床疗效评估,采用Beals和Tower标准行假体周围骨折影像学评估,记录相关并发症.结果 2例分别于伤后3个月和5个月死亡.其余20例获得平均3年(1～6年)的随访,末次随访时Harris评分平均为85.4分(50～ 100分).骨折均获得愈合,愈合时间平均为4.8个月(3～8个月).PFF影像学评估按照Beals和Tower标准:优16例,良1例,差3例.并发症:1例B1型骨折术后发生浅表感染,1例C型骨折术后6个月发生钢板远端股骨骨折,1例B2型骨折术后4个月发生B1型骨折.无畸形愈合、内固定失效、脱位、假体松动等并发症发生.结论 改良Vancouver分类对于PFF治疗方法的选择具有指导意义,按照不同的分类选择相应的治疗方法可以获得满意的临床疗效.%Objective To discuss the classification systems and treatment protocols for periprosthetic femoral fracture (PFF) after hip arthroplasty.Methods The study enrolled 22 cases (22 hips) of PFF after hip arthroplasty treated from November 2006 to October 2013.There were 13 males and 9 females with mean age of 76.8 years (range,51-91 ycars).According to thc modified Vancouver classification,one case was grouped to type TG,1 type A1,6 type B1,10 type B2,1 type B3,and 3 type C.Two cases underwent conservative treatment,but the remaining 20 cases were treated surgically among which 9 had internal fixation and 11 had long-stem revision.At the final follow-up evaluation,Harris hip score was used for clinical results and Beals and Tower' s criteria for radiological results.Complications were also recorded.Results Two cases died at postoperative 3 months and 5 months respectively.Twenty cases were followed up for mean 3 years (range,1-6 years).Mean Harris hip score was 85.4 points (range,50-100 points).Bone healed in average 4.8 months (range,3-8 months).According to the Beals and Tower' s criteria,the results were excellent in 16 cases,good in 1 and poor in 3.Postoperative complications were observed in 3 cases,including superficial infection in one case of type B1,distal femoral fracture in 1 case of type C and type B1 fracture in 1 case of type B2.There were no signs of malunion,implant failure,dislocation and loosening of the prosthesis.Conclusions The modified Vancouver classification may be helpful for treatment decision.Treatment choices based on fracture classification attain good clinical outcome.