初次生物柄全髋置换术术中假体周围骨折：发生率、处理、预后

发布时间：2018-03-02 09:54

本文关键词： 初次全髋关节置换术假体周围骨折术中骨折生物柄　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过分析初次全髋关节置换术(Total Hip Arthroplasty,THA)术中假体周围股骨骨折病例,探讨骨折发生的影响因素,并分析与所植入生物柄相关的假体周围骨折的发病率、处理和预后。方法:对我院由同一名主刀医师在2006年1月至2012年4月期间连续进行的559例全髋关节置换术术中使用的623个植入假体进行回顾性研究。查阅这些患者术后即刻进行的X线片检查及手术记录,将手术记录描述发生骨折及术后X线片检查出现假体周围骨折的病例纳入研究队列。从患者的病历中获取包括年龄、性别、体重、身高等人口统计学数据,并自手术记录确定术中所用股骨假体柄的远端直径、长度、偏心距及骨折所采取的术中、术后治疗方案。对研究队列中的患者进行术后随访,并对所有数据进行统计分析,了解骨折的影响因素及预后情况。结果:所有患者手术均顺利进行,共收集到43例术中假体周围股骨骨折病例,按术中骨折Vancouver分型方法进行分类,A1型5例,B1型3例,B2型13例,A2L型6例,A2G型6例,A3L型8例,A3G型2例,分别采用钢丝环扎固定、术后卧床等治疗。术后43例患者均获得满意随访,随访时间12~37个月,平均随访21.6个月,所有患者均未见假体松动、下沉。Harris评分为77~91分,平均为85.21分。采用SPSS18.0软件二项逻辑回归统计分析,结果提示性别(P=0.002)和假体柄直径(P=0.031)是术中骨折的危险因素,女性患者骨折的发生率高于男性,同时假体柄直径越大伴随的骨折风险越高。结论:假体周围骨折与性别存在绝对相关,女性患者更易发生术中骨折,且骨折与假体远端直径的相关性较明显(P=0.031),针对Vancouver A1、A2L、A2G、B1、B2型骨折,术中均未采取任何附加治疗措施,仅术后相应延长下地负重时间,而Vancouver A3L、A3G型的假体周围骨折术中采用钢丝环扎固定并延长术后卧床时间至骨折愈合,改方法可促进骨折愈合不影响术后功能。
[Abstract]:Objective: to analyze the incidence of periprosthetic femoral fractures in the first total Hip arthroplasty (THAA) operation, and to explore the influencing factors and the incidence of periprosthetic fractures associated with the implanted biological handle. Methods: a retrospective study of 623 implants used in total hip arthroplasty from January 2006 to April 2012 by the same surgeon in our hospital was carried out. X-ray examination and operation record immediately after operation, The study cohort cohort the patients with surgical records describing the fracture and the periprosthetic fracture after X-ray examination. The data included age, sex, weight, height and other demographic data from the patient's medical records. The distal diameter, length, eccentricity and fracture of the femoral prosthetic handle used in the operation were determined from the operation records. The patients in the study cohort were followed up after operation and all the data were statistically analyzed. Results: all the patients underwent the operation successfully. A total of 43 cases of periprosthetic femoral fractures were collected. According to the Vancouver classification method of intraoperative fracture, 5 cases of type A1, 3 cases of type B1, 13 cases of type B2, 13 cases of type A 2L, 6 cases of type A 2G, 6 cases of type A 3L, 8 cases of type A3G, were treated with wire ring fixation and bed rest after operation. All the patients were followed up satisfactorily. All patients were followed up for 12 ~ 37 months with an average of 21.6 months. No prosthetic loosening was found in all patients. The results suggested that the sex of P0. 002) and the diameter of prosthetic handle P0. 031) were the risk factors of intraoperative fracture. The incidence of fracture in female patients was higher than that in men. At the same time, the greater the diameter of the prosthetic handle, the higher the fracture risk. Conclusion: the periprosthetic fracture is absolutely correlated with the sex, and the female patients are more likely to have intraoperative fracture, and the correlation between the fracture and the distal diameter of the prosthesis is more obvious. No additional treatment was taken during the operation, only the time of weight loading was prolonged after operation, while the periprosthetic fracture of Vancouver A3LN A3G was fixed with steel wire loop and the time of bed-rest after operation was prolonged until the fracture healed. The modified method can promote fracture healing without affecting postoperative function.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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