目的 探讨人工髋关节置换术后Vancouver B1型股骨假体周围骨折的治疗方法。 方法 2006年4月－2011年2月采用记忆合金抓握式接骨板固定结合自体髂骨植骨治疗6例Vancouver B1型股骨假体周围骨折。其中男2例，女4例；年龄55～78岁，平均68.5岁。6例均为初次行人工关节置换术后6个月～3年，平均18.4个月发生假体周围骨折；骨折至手术时间为3～6 d，平均4.2 d。 结果 术后切口均Ⅰ期愈合，无深静脉血栓形成、肺部感染、肺栓塞等并发症发生。6例均获随访，随访时间13个月～4年，平均28.6个月。X线片示骨折全部愈合，愈合时间12～20周，平均14.8周。末次随访时Harris评分76～93分，平均83.6分；获优3例，良3例。无1例出现接骨板折断、松动，骨折再移位、骨不连、股骨假体松动等并发症。 结论 记忆合金抓握式接骨板结合自体髂骨植骨治疗Vancouver B1型股骨假体周围骨折具有固定可靠、操作简便的特点，可获满意临床疗效。
Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
Objective To evaluate the mid-term effectiveness of two-stage hip prosthesis revision in the treatment of infection after hip arthroplasty. Methods Between April 2002 and November 2006, 12 cases of infection after hip arthroplasty were treated. There were 5 males and 7 females, aged from 47 to 72 years (mean, 59.8 years). The femoral head arthroplasty wasperformed in 2 cases and total hip arthroplasty in 10 cases. Infection occurred 1 to 67 months after arthroplasty. According to the Segawa classification criteria, infections included type 2 in 1 case, type 3 in 2 cases, and type 4 in 9 cases. The preoperative Harris score was 36.7 ± 6.1. Nine cases had elevated C reactive protein and 10 cases had elevated erythrocyte sedimentation rate. The results of bacterial culture were positive in 8 cases and negative in 4 cases. After the removal of the infected prosthesis and thorough debridement, antibiotic-loaded cement spacers or infected therapeutic temporary prosthesis were used as placeholders, and then the anti-infection treatments were given after operations; two-stage hip prosthesis revisions were performed 3 to 10 months after debridement. Results In 1 patient who failed to control infection after debridement, infection was controlled after the second debridement and the antibiotic-loaded cement spacer as placeholder. Other patients achieved heal ing of incision by first intention, and no compl ication such as deep venous thrombosis and nerve injury occurred. All patients were followed up 3 to 8 years after revision (mean, 5.4 years). During the follow-up, no infection recurrence and joint dislocation occurred. Dull pain was present in 2 cases during activity and mild claudication in 3 cases at last follow-up. The Harris score was 81.6 ± 4.5, showing significant difference (t=52.696, P=0.000) when compared with preoperative score. The X-ray films showed that noprosthesis loosening and obvious subsidence were observed, and bone graft healed. Conclusion The two-stage hip prosthesis revision has good infection control rate and mid-term effectiveness in treatment of infection after hip arthroplasty.
Objective To study the operative methods and therapeutic effects of acetabulum reinforcement ring in the reconstruction of acetabular defects in primary and revisional artificial hip replacement. Methods From November 2000 to July 2005, 14 cases (15 hips) of severe acetabular defects in artificial hip replacement were treated with acetabulum reinforcement ring combined autogenous or allogenic bone transplantation, including 7 males and 8 females aged 34-72 years with an average of 55 years. Among them, 9 cases (9 hips) underwent artificial hip joint revision, which was 3-22 years (average8.9 years) far away from their primary replacement, and 5 cases (6 hi ps) received primary replacement, including 1 case of rheumatoid arthritis of both hips, 1 osteoarthritis caused by acetabular dysplasia, 1 femoral head resection due to debridement of hi p infection, 1 nonunion of acetabulum old fracture with the center dislocation of femoral head and 1 old acetabulum fracture. The disease course was 2-25 years (average 11.6 years). According to the American Academy of Orthopaedic Surgeons (AAOS) classification, the acetabulum defects of 7 hips were categorized into Type II, 6 hips were Type III and 2 hips were Type IV. Harris score was (59.1 ± 15.4) points preoperatively. Results All wounds were healed by first intention. The symptom of sciatic nerve simulation was occurred in 1 case and was rel ieved after taking neuroprotective drug for 5 months. All the cases were followed up for 33-90 months (average 51.3 months). Harris score at the final follow-up was (81.9 ± 10.4) points, indicating there was a significant difference between before and after operation (P lt; 0.01). X-ray film demonstrated that the displacement of acetabulum reinforcement ring and acetabular cup was less than 5 mm, the rotation was less than 5°, and there was no progressive radiolucent zone around acetabulum and screw. Conclusion Acetabulum reinforcement ring is beneficial to reconstruct severe acetabular defects, improve hip joints’ function and provide primary stabil ity for putting acetabular cup into an ideal biomechanical position.
Objective To summarize and analyze the clinical experience and theclinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. Methods Eleven patients (7 males and4 females, aged 40-69 years) with a tumorous disease in the proximal femur received a removal ofthe proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. Results The follow-upfor 1-5 years in 9 patients (2 patients lost the follow-up) revealed that afteroperation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the “0” degree, a decreased sensation, the “3” degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle powertest showed that 5 patients had the “3” degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the “4” degree of the quadriceps muscle power, with an extension range of the hip joint of 10°27° and an average flexion degree of 74°. According to the Harris scale, 3 patientswere assessed to be good (8089), 5 moderate (70-79), but 1 bad (lt;70). No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. Conclusion The customized hip arthroplasty has a goodclinical outcome in treatment of a tumorous disease in the proximal femur. However, there is a high incidence of deficiency of the quadriceps muscle power after operation, which may be relevant to the removal of the upper attachment of the quadriceps muscle. If the attachment of the quadriceps muscle, especially the internal, external and posterior septum attachment, can be fixed in the body of the prosthesis during operation, the power of the quadriceps muscle can be enhanced and the patient can have a better therapeutic effect.
Objective Use the method of Cochrane systematic review to evaluate the difference of two fixation methods of femoral component in hip arthroplasty in order to choose the most appropriate fixation method. Methods Searches was applied to the following electronic databases: Chinese Bimedical Database (CBM) (1979 to Dec. 2004), MEDLINE (1966 to Feb. 2005), EMBASE (1984 to 2004) and The Cochrane Library (Issue 4, 2004). We handsearched Chinese Journal of Orthopaedy, the Journal of Bone and Joint Injury and Orthopaedic Journal of China (from establishment to Feb. 2005). Randomized controlled trials (RCT) were indentified and we applied RevMan 4.2 for statistical analysis. Results Nine RCTs involving 1 075 hips were included. The combined results of meta-analysis showed that the embolization occurred more commonly in the first and second generation cemented group (OR 0.02, 95%CI 0 to 0.11, P＜0.000 01), but this difference was not seen between the third generation cemented group and uncemented group (OR 0.80, 95%CI 0.36 to 1.78, P=0.58); The subsidence of femoral component (OR 12.20, 95%CI 3.58 to 41.54, P＜0.000 1) and the cortical hypertrophy (OR 69.97, 95%CI 27.88 to 175.57, P＜0.000 01) were more commonly found in uncemented group; the thigh pain occurrence, the revision for the femoral component’s cause and heterotopic ossification were found no significant difference in the two groups. Conclusions Compared with noncemented group, we found that cemented fixation may be more associated with embolism in the first and second generation cemented technique and less with femoral subsidence and cortical hypertrophy. There was no significant difference in embolization between the third generation cemented technique group and noncemented group. However, more randomized controlled trials to evaluate the occurrence of the postoperative thigh pain, revision and heterotopic ossification are needed.
【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.
ObjectiveTo observe the changing patterns of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum amyloid A protein (SAA) levels before and after hip replacement surgery, and explore their clinical significances. MethodsNinety-seven consecutive patients enrolled in clinical pathway in our hospital for hip replacement from April 2011 to May 2013 were included in the present study. ESR, CRP and SAA levels were investigated preoperatively and post-operatively at day 1, 3, 5, 7, 14, Month 1 and 3. All the cases were followed up, among which there were 14 cases of total hip replacement, 56 cases of cementless hemianthroplasty, and 27 cases of biotype hemianthroplasty. ResultsAll three of ESR, CRP and SAA levels were elevated post-operatively. Levels of CRP and SAA peaked at day 3 after surgery, and then subsided gradually to pre-operative levels after 1 month. ESR level peaked at day 7 postoperatively, and then subsided gradually to pre-operative levels after 3 months. There was a significant correlation between levels of CRP and levels of SAA. ConclusionCompared with ESR and SAA, CRP appears to be a faster and more sensitive parameter. Cementless hemianthroplasty is associated with changes of SAA levels but not with CRP levels. Close monitoring of evolutionary changes in ESR, SAA and CRP levels may help to diagnose and treat early infection after hip replacement surgery.
ObjectiveTo investigate the clinical e cacy of hip arthroplasty in treating intracapsular femoral neck fracture in elderly patients. MethodsFrom January 2010 to December 2012, 198 patients with intracapsular femoral neck fractures (Garden Ⅲ and Ⅳ ), aged between 65 and 85 years old were selected to be treated with hip arthroplasty. Clinical evaluation including Harris hip score, Barthel index, postoperative complications and activities of daily living were performed. ResultsThe patients were followed up for an average time of 15.6 months. At the follow-up time of 12 months, the Harris scores were 85-98, averaging 94.5; the Barthel indexes were 86-97, averaging 94.0. The main postoperative complications were subcutaneous fat necrosis (3 cases), deep venous thrombosis of lower limbs (2 cases), bedsores (2 cases), pulmonary infection (4 cases), dislocation (2 cases) and pain (4 cases). More than 95% of the patients had a satisfactory treatment and recovered activities of daily living. ConclusionHip arthroplasty reduces postoperative complications caused by prolonged bed rest and helps the patients get back to normal activities of daily living early, so it is an effective method to treat intracapsular femoral neck fractures and is suitable for widespread clinical application.