本文關(guān)鍵詞： 初次全髖關(guān)節(jié)置換術(shù) 假體周圍骨折 術(shù)中骨折 生物柄　出處：《福建醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過分析初次全髖關(guān)節(jié)置換術(shù)(Total Hip Arthroplasty,THA)術(shù)中假體周圍股骨骨折病例,探討骨折發(fā)生的影響因素,并分析與所植入生物柄相關(guān)的假體周圍骨折的發(fā)病率、處理和預(yù)后。方法:對(duì)我院由同一名主刀醫(yī)師在2006年1月至2012年4月期間連續(xù)進(jìn)行的559例全髖關(guān)節(jié)置換術(shù)術(shù)中使用的623個(gè)植入假體進(jìn)行回顧性研究。查閱這些患者術(shù)后即刻進(jìn)行的X線片檢查及手術(shù)記錄,將手術(shù)記錄描述發(fā)生骨折及術(shù)后X線片檢查出現(xiàn)假體周圍骨折的病例納入研究隊(duì)列。從患者的病歷中獲取包括年齡、性別、體重、身高等人口統(tǒng)計(jì)學(xué)數(shù)據(jù),并自手術(shù)記錄確定術(shù)中所用股骨假體柄的遠(yuǎn)端直徑、長(zhǎng)度、偏心距及骨折所采取的術(shù)中、術(shù)后治療方案。對(duì)研究隊(duì)列中的患者進(jìn)行術(shù)后隨訪,并對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,了解骨折的影響因素及預(yù)后情況。結(jié)果:所有患者手術(shù)均順利進(jìn)行,共收集到43例術(shù)中假體周圍股骨骨折病例,按術(shù)中骨折Vancouver分型方法進(jìn)行分類,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,分別采用鋼絲環(huán)扎固定、術(shù)后臥床等治療。術(shù)后43例患者均獲得滿意隨訪,隨訪時(shí)間12~37個(gè)月,平均隨訪21.6個(gè)月,所有患者均未見假體松動(dòng)、下沉。Harris評(píng)分為77~91分,平均為85.21分。采用SPSS18.0軟件二項(xiàng)邏輯回歸統(tǒng)計(jì)分析,結(jié)果提示性別(P=0.002)和假體柄直徑(P=0.031)是術(shù)中骨折的危險(xiǎn)因素,女性患者骨折的發(fā)生率高于男性,同時(shí)假體柄直徑越大伴隨的骨折風(fēng)險(xiǎn)越高。結(jié)論:假體周圍骨折與性別存在絕對(duì)相關(guān),女性患者更易發(fā)生術(shù)中骨折,且骨折與假體遠(yuǎn)端直徑的相關(guān)性較明顯(P=0.031),針對(duì)Vancouver A1、A2L、A2G、B1、B2型骨折,術(shù)中均未采取任何附加治療措施,僅術(shù)后相應(yīng)延長(zhǎng)下地負(fù)重時(shí)間,而Vancouver A3L、A3G型的假體周圍骨折術(shù)中采用鋼絲環(huán)扎固定并延長(zhǎng)術(shù)后臥床時(shí)間至骨折愈合,改方法可促進(jìn)骨折愈合不影響術(shù)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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 湯冀強(qiáng);;Vancouver B1型股骨假體周圍骨折的手術(shù)治療[J];實(shí)用骨科雜志;2011年12期

，

本文編號(hào)：1556025