切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 416 -420. doi: 10.3877/cma.j.issn.1674-134X.2018.03.021

所属专题: 文献

临床经验

Zweymυ¨ller型柄髋关节置换术后股骨侧假体周围骨折的手术治疗
方超华1, 龚凯2, 王识程1, 狄正林1, 何志勇1, 章军辉1,()   
  1. 1. 315000 宁波市第六医院关节外科
    2. 310053 杭州,浙江中医药大学第二临床医学院
  • 收稿日期:2017-05-22 出版日期:2018-06-01
  • 通信作者: 章军辉

Surgical treatment of femoral periprosthetic fracture following hip arthroplasty with Zweymυ¨ller stem

Chaohua Fang1, Kai Gong2, Shicheng Wang1, Zhenglin Di1, Zhiyong He1, Junhui Zhang1,()   

  1. 1. Department of Joint Surgery, Ningbo sixth Hospital, Ningbo 315000, China
    2. 2nd Clinical Medicine College, Zhejiang Chinese medical university, Hangzhou 310053, China
  • Received:2017-05-22 Published:2018-06-01
  • Corresponding author: Junhui Zhang
  • About author:
    Corresponding author: Zhang Junhui, Email:
引用本文:

方超华, 龚凯, 王识程, 狄正林, 何志勇, 章军辉. Zweymυ¨ller型柄髋关节置换术后股骨侧假体周围骨折的手术治疗[J/OL]. 中华关节外科杂志(电子版), 2018, 12(03): 416-420.

Chaohua Fang, Kai Gong, Shicheng Wang, Zhenglin Di, Zhiyong He, Junhui Zhang. Surgical treatment of femoral periprosthetic fracture following hip arthroplasty with Zweymυ¨ller stem[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 416-420.

目的

报道应用Profemur?Z柄行初次髋关节置换术后股骨侧假体周围骨折病例6例手术治疗后效果。

方法

纳入宁波市第六医院关节外科2009至2017年期间因终末期髋关节病或股骨颈骨折行初次髋关节置换术,术后外伤后发生假体周围骨折病例共6例(7髋)。其中5髋为长螺旋、长斜形或粉碎性骨折,2髋为短斜形骨折;Vancouver B1型2髋,B2型5髋,术中股骨侧假体根据不同骨折情况选用不同翻修方式,分别行单纯骨折复位内固定术和关节翻修术加骨折复位内固定术,并随访其疗效。

结果

本组患者术后随访均未出现假体松动或假体周围骨溶解等并发症,所有病例未发生术后并发症。术后3月X线显示骨折均愈合,患髋功能恢复好,末次随访髋关节功能HSS评分平均(85.5±4.5)分。

结论

Profemur?Z柄初次髋关节置换术后发生假体周围骨折可根据骨折分型给予内固定或翻修手术治疗,术后随访显示功能恢复好,骨折与假体形态设计的相关性需要生物力学研究。

Objective

To report therapeutic effects of surgical treatment on six cases of femoral periprosthetic fracture after primary hip arthroplasty with Profemur? Z stem.

Methods

Six cases (seven hips) who received primary hip arthroplasty for end stage of hip osteopathy or femoral neck fracture were collected during 2009 to 2017. All the cases used the Profemur? Z stem and all of them had no metabolic bone diseases but suffered from postoperative femoral periprosthetic fractures after trauma, including five hips of long spiral, long oblique or comminuted fractures and two hips of short oblique fracture. Two hips were Vancouver B1 type and five hips were B2 type. Surgeries were performed according to Vancouver classification, open reduction and internal fixation(ORIF), or revision arthroplasty plus ORIF were conducted respectively.

Results

No postoperative complication happened, and fractures were all healed at three months postoperatively. Good hip function was obtained in all the cases; HSS score was (85.5±4.5) on average at the time of latest follow-up.

Conclusion

The femoral periprosthetic fractures following primary hip arthroplasty with Profemur? Z stem can be effectively l treated by surgical treatment according to Vancouver classification.

图1 双侧Vancouver B2型骨折,行大号Profemur? Z柄加用捆绑带翻修术前后X线片。图A 双侧全髋关节置换术后X线片,周围骨质正常;图B 双侧全髋关节置换术后X线片,双侧股骨假体周围骨折(Vancouver B2型);图C 双侧髋关节翻修术后X线片,大号Profemur? Z柄翻修加用捆绑带固定
图3 左侧Vancouver B1型骨折,行MP柄加用捆绑带翻修术前后X线片。图A 左侧全髋关节置换术后X线片,示假体周围骨折(Vancouver B2型);图B 左侧髋关节翻修术后X线片,MP柄翻修加用捆绑带固定术后
[1]
Phillips J, Boulton C, Moran CG, et al. What is the financial cost of treating periprosthetic hip fractures?[J]. Injury, 2011, 42(2):146-149.
[2]
Lindahl H, Garellick G, Regner H, et al. Three hundred and twenty-one periprosthetic femoral fractures[J]. J Bone Joint Surge Am, 2006, 88A(6):1215-1222.
[3]
Abdel MP, Cottino U, Mabry TM. Management of periprosthetic femoral fractures following total hip arthroplasty: a review[J]. Int Orthop, 2015, 39(10):2005-2010.
[4]
Lowenhielm G, Hansson LI, Karrholm J. Fracture of the lower extremity after total hip replacement[J]. Arch Orthop Trauma Surg, 1989, 108(3):141-143.
[5]
Duncan CP, Masri BA. Fractures of the femur after hip replacement[J]. Instr Course Lect, 1995, 44:293-304.
[6]
Bohm G, Lintner F, Auterith A, et al. Morphometric examination of straight, tapered Titanium stems-A retrieval study[J]. Clin Orthop Relat Res, 2001, 393:13-24.
[7]
Affatato S, Comitini S, Fosco M, et al. Radiological identification of Zweymüller-type femoral stem prosthesis in revision cases[J]. Int Orthop, 2016, 40(11):2261-2269.
[8]
Busch VJ, Pouw MH, Laumen AM, et al. Long-term outcome of 73 Zweymüller total hip prostheses with a screw cup in patients under 50 years of age[J]. Hip Int, 2012, 22(3):292-295.
[9]
Kolb A, Gruebl A, Schneckener CD, et al. Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem a concise follow-up, at a minimum of twenty years, of previous reports[J]. J Bone Joint Surg Am, 2012, 94A(18):1681-1684.
[10]
Silverton CD, Jacobs JJ, Devitt JW. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis[J]. Arthroplasty, 2014, 29(9):1768-1773.
[11]
Pour AE, Borden R, Murayama TA, et al. High risk of failure with bimodular femoral components in THA[J]. Clin Orthop Relat Res, 2016, 474(1):146-153.
[12]
Abdel MP, Watts CD, Houdek MT, et al. Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties a 40-year experience[J]. Bone Joint J, 2016, 98B(4):461-467.
[13]
Grammatopoulos G, Pandit H, Kambouroglou GA, et al. A unique peri-prosthetic fracture pattern in well fixed femoral stems with polished, tapered, collarless design of total hip replacement[J]. Injury, 2011, 42(11):1271-1276.
[14]
Sheth NP, Brown NM, Moric M, et al. Operative treatment of early peri-prosthetic femur fractures following primary total hip arthroplasty[J]. Arthroplasty, 2013, 28(2):286-291.
[15]
Watts CD, Abdel MP, Lewallen DG, et al. Increased risk of periprosthetic femur fractures associated with a unique cementless stem design[J]. Clin Orthop Relat Res, 2015, 473(6):2045-2053.
[16]
Hirata Y, Inaba Y, Kobayashi N, et al. Comparison of mechanical stress and change in bone mineral density between two types of femoral implant using finite element analysis[J]. J Arthroplasty, 2013, 28(10):1731-1735.
[17]
Lim SJ, Lee KJ, Min BW, et al. High incidence of stem loosening in association with periprosthetic femur fractures in previously well-fixed cementless grit-blasted tapered-wedge stems[J]. Int Orthop, 2015, 39(9):1689-1693.
[18]
方超华,凌晶,李明,等.广泛多孔涂层柄应用于初次髋关节置换术后假体无菌性松动翻修的短中期疗效分析[J].中国骨与关节损伤杂志,2017,32(02):125-128.
[19]
徐勇强,王愉思,阎戈,等.组配式生物型股骨假体行一期人工髋关节翻修术13例[J].中国骨与关节损伤杂志,2012,27(12):1102-1103.
[20]
王健,肖军,赵亮,等.非骨水泥锥形方柄在股骨近端骨缺损翻修重建中的作用[J].中华骨科杂志,2016,36(23):1517-1523.
[1] 许银峰, 盛璞义, 余世明, 张阳春. 偏心性髋臼旋转截骨术治疗发育性髋关节发育不良[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 568-574.
[2] 陈晓玲, 钟永洌, 刘巧梨, 李娜, 张志奇, 廖威明, 黄桂武. 超高龄髋膝关节术后谵妄及心血管并发症风险预测[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 575-584.
[3] 马桥桥, 张传开, 郭开今, 蒋涛, 王子豪, 刘勇, 郝亮. 可降解止血粉减少初次全膝关节置换术失血量的研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 585-589.
[4] 刘涛, 樊保佑, 史仲举, 刘德荣, 王沛. 股骨距是一个容易被误解的人体结构[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 626-629.
[5] 李焕玺, 何淳诺, 田志敏, 周胜虎, 吴昊越, 张浩强. 全膝关节置换术后股骨远端假体周围骨折治疗现状[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 630-637.
[6] 王相迎, 杨长生, 曲铁兵. 固定平台单髁置换假体合适位置的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 638-645.
[7] 苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[8] 郭艳波, 马亮, 李刚, 阎伟, 骆帝, 岳亮, 吴伟山. 全膝关节置换术后胫股关节脱位的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 658-671.
[9] 陈翠萍, 李佩君, 杜景榕, 谢青梅, 许一宁, 卓姝妤, 李晓芳. 互联网联合上门护理在老年全髋关节置换术后的应用效果[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 676-681.
[10] 丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[11] 孔德铭, 刘铮, 李睿, 钱文伟, 王飞, 蔡道章, 柴伟. 人工智能辅助全髋关节置换三维术前规划准确性评价[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 431-438.
[12] 房桂彬, 肖进, 傅光涛, 郑秋坚. 老年髋部骨折患者术后1年行走能力的影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 273-280.
[13] 茹江英, 廖启宇, 温国洪, 潘思华, 刘栋, 张皓琛, 牛云飞. 直接前方入路和后外侧入路半髋关节置换治疗老年痴呆股骨颈骨折的疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 287-293.
[14] 王松雷, 张贻良, 孟浩, 宋威, 白林晨, 袁心, 张辉. 股骨前髁预截骨髓外定位技术在全膝关节置换术中的应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 811-819.
[15] 刘建, 王文珠, 王倩. 老年髋部骨折术后肺损伤现状调查分析及影响因素研究[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 260-264.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?