【摘要】 目的 探讨人工髋关节置换术后股骨假体周围骨折的治疗方法及疗效。 方法 回顾分析2001年3月-2009年3月11例股骨假体周围骨折，均为人工股骨柄周围骨折，Vancouver B1型假体无明显松动，均行切开复位，用形状记忆合金环抱器内固定并取髂骨或人工骨植骨治疗。术后随访9~25个月，平均13个月。 结果 术后3~6个月，11例骨折均愈合，平均愈合时间4.5个月。患者无感染、假体松动脱位、内固定断裂和深静脉血栓形成。根据HARRIS髋关节功能评估法估分:优6例，良4例，可1例。 结论 形状记忆合金环抱器不损害假体周围骨皮质及假体或其骨水泥层，操作简便，是治疗人工髋关节置换术后股骨假体周围骨折的较理想的一种方法。【Abstract】 Objective To investigate the therapeutic method and effect of periprosthetic femur fracture after hip arthroplasty. Methods Eleven patients with fracture around the prosthetic femoral stem were included. Prostheses of Vancouver B1 were fixed tightly. All patients accepted reposition enchevillement, intracontention with shape memory alloy encircled fixer, and bone grafting with autologous ilium or artificial bones. The follow-up was nine to 25 months,with the average 13 months. Results All the fracures healed in three to six months after treatment,the average healing time was 4.5 months. There was no infection, loosing or dislocatin of prosthesis. Cracking of internal fixation and thrombosis of deep venouses did not occured either. The excellent healing rate was 10/11 according to Harris hip score. Conclusion Intracontention with shape memory alloy encircled fixer is a good method to fix the fracture around the femur prosthesis, which is easy to manifacture and does no harm to bone cortex around the prosthesis, along with the prosthesis itself and the bone cement layer.
Objective To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty. Methods The clinical data of 30 patients (30 hips) with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively. Among them, 15 cases were treated with shape memory alloy embracing device for fracture fixation (group A) and 15 cases with titanium cable cerclage (group B). There was no significant difference in general data such as gender, age, body mass index, the cause of primary arthroplasty and surgical method, prosthesis type, the cause and side of femoral fracture, the time from injury to operation, and comorbidities between the two groups (P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The fracture healing was examined by X-ray film, and the hip joint function was evaluated by Harris score. Results The operations in both groups were completed successfully, and the incisions healed by first intention after operation with no vascular or nerve injury. The operation time and hospital stay in group A were significantly shorter than those in group B (P<0.05), but there was no significant difference in intraoperative blood loss between group A and group B (t=−0.518, P=0.609). Patients were followed up 12-20 months (mean, 16.3 months) in group A and 12-22 months (mean, 16.7 months) in group B. X-ray film showed that all fractures healed, the healing time was (14.73±2.05) weeks in group A and (17.27±2.60) weeks in group B, and there was a significant difference between the two groups (t=−2.960, P=0.006). During follow-up, there was no complication such as prosthesis loosening, periprosthetic infection, joint stiffness, or internal fixator loosening. The Harris score of group A was significantly better than that of group B at 3, 6, and 12 months after operation (P<0.05). Conclusion Compared with titanium cable cerclage, using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing, shorten operation time, and reduce intraoperative blood loss. Patients can perform functional exercise earlier and restore joint function better.