人工全髋关节股骨假体周围骨折的临床特点研究及其危险因素分析

发布时间：2018-10-16 14:36

【摘要】：目的：对人工全髋关节股骨假体周围骨折(periprosthetic femoral fractures, PFF)患者的临床特征进行研究,并分析髋关节初次置换及翻修术中、术后PFF的相关危险因素,以期对临床预防提供一定的指导意义。方法：1、临床特征研究：对2010年1月至2014年12月我院骨关节科89例股骨假体周围骨折患者临床资料进行回顾性研究,根据骨折发生时间分为初次置换术中骨折患者30例、初次置换术后骨折患者8例、翻修术中骨折患者46例及翻修术后骨折患者5例。对PFF发病率、患者一般资料、关节置换原发疾病、翻修原因、骨折分型、假体使用情况、术后骨折发生时间以及治疗方法的选择等进行资料整理分析。2、危险因素分析：选取同时期行关节置换或翻修未发生骨折的患者,按照1：2比例确定178例作对照,使用Logistic回归统计学方法分别分析初次髋关节置换及翻修术PFF发生的危险因素,具体包括患者一般资料(性别、年龄、BMI等)、骨质情况、术前诊断、假体类型、既往髋关节手术类型及次数、股骨畸形、伴随疾病等。结果：1、,临床特征：总体术中PFF发生率为1.77%,术后发生率为0.30%,翻修术骨折发生率高于初次置换术,分别为13.60%、0.97%(X2=268.45,P=0.00)。初次置换术中骨折多见于DDH患者,Vancouver A2型骨折多见(19/30),翻修术中骨折多见于无菌性松动患者,多为B3、A3型骨折(24/46；12/46)。翻修术中骨折患者有6例存在股骨畸形,骨折部位均与畸形位置一致。术后骨折患者大多数有明确的摔伤病史(12/13),骨折分型多为B型。术中骨折治疗多选用钢丝或捆绑带,术后多选用切开复位钢板内固定术。初次置换术中骨折患者中,骨质情况差者(CBR≥0.49)占66.7%。2、危险因素：经多因素分析显示：DDH与术前CBR≥0.49为初次置换术中PFF的危险因素,年龄增大为初次置换术后PFF的危险因素;翻修手术前手术次数的增加、因感染翻修、术前生物型假体的使用以及股骨畸形存在会增加翻修术中PFF的发生率。翻修术亦是PFF的危险因素之一。结论：PFF是髋关节置换与翻修术重要的并发症之一,明确其危险因素对该并发症的预防有一定的指导意义,做好术前准备、术中仔细操作、加强出院患者指导可减少骨折发生,治疗依据Vancouver分型选择内固定或更换假体,根据骨折处理原则进行捆绑、钢板、骨板固定。
[Abstract]:Objective: to study the clinical features of (periprosthetic femoral fractures, PFF) patients with periprosthetic fracture of total hip, and to analyze the risk factors of PFF during primary hip replacement and revision. In order to provide certain guiding significance for clinical prevention. Methods: 1. Clinical characteristics: from January 2010 to December 2014, the clinical data of 89 patients with periprosthetic fracture of femur in our hospital were retrospectively studied. There were 8 cases of fracture after primary replacement, 46 cases of fracture during revision operation and 5 cases of fracture after revision. For the incidence of PFF, general data of patients, primary diseases of joint replacement, revision causes, fracture classification, prosthesis use, The time of fracture occurrence and the choice of treatment methods were analyzed. 2. Risk factor analysis: 178 patients who had undergone joint replacement or revision at the same time were selected as control group. Logistic regression was used to analyze the risk factors of PFF in primary hip replacement and revision, including general data of patients (sex, age, BMI, etc.), bone condition, preoperative diagnosis, type of prosthesis. Types and times of previous hip joint surgery, femoral deformity, associated diseases, etc. Results: (1) Clinical features: the overall incidence of PFF during operation was 1.777.The incidence of postoperative PFF was 0.30.The incidence of fracture in revision operation was higher than that in primary replacement (13.600.97%) (X _ 2: 268.45P _ (0.00). In primary replacement, fractures were found in DDH patients, Vancouver A2 fractures (19 / 30), revision fractures in aseptic loosening patients, mostly B3A3 fractures (24 / 46 / 12 / 46). Femoral malformation was found in 6 cases of fracture during revision operation, and the site of fracture was the same as that of malformation. Most of the fracture patients had a definite history of fall (12 / 13), and most of the fracture types were B type. During the treatment of fracture, steel wire or binding band was used, and open reduction and internal fixation with steel plate was used after operation. Among the patients with fracture in primary replacement, the patients with poor bone condition (CBR 鈮，

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