【摘要】：目的：對(duì)人工全髖關(guān)節(jié)股骨假體周圍骨折(periprosthetic femoral fractures, PFF)患者的臨床特征進(jìn)行研究,并分析髖關(guān)節(jié)初次置換及翻修術(shù)中、術(shù)后PFF的相關(guān)危險(xiǎn)因素,以期對(duì)臨床預(yù)防提供一定的指導(dǎo)意義。方法：1、臨床特征研究：對(duì)2010年1月至2014年12月我院骨關(guān)節(jié)科89例股骨假體周圍骨折患者臨床資料進(jìn)行回顧性研究,根據(jù)骨折發(fā)生時(shí)間分為初次置換術(shù)中骨折患者30例、初次置換術(shù)后骨折患者8例、翻修術(shù)中骨折患者46例及翻修術(shù)后骨折患者5例。對(duì)PFF發(fā)病率、患者一般資料、關(guān)節(jié)置換原發(fā)疾病、翻修原因、骨折分型、假體使用情況、術(shù)后骨折發(fā)生時(shí)間以及治療方法的選擇等進(jìn)行資料整理分析。2、危險(xiǎn)因素分析：選取同時(shí)期行關(guān)節(jié)置換或翻修未發(fā)生骨折的患者,按照1：2比例確定178例作對(duì)照,使用Logistic回歸統(tǒng)計(jì)學(xué)方法分別分析初次髖關(guān)節(jié)置換及翻修術(shù)PFF發(fā)生的危險(xiǎn)因素,具體包括患者一般資料(性別、年齡、BMI等)、骨質(zhì)情況、術(shù)前診斷、假體類型、既往髖關(guān)節(jié)手術(shù)類型及次數(shù)、股骨畸形、伴隨疾病等。結(jié)果：1、,臨床特征：總體術(shù)中PFF發(fā)生率為1.77%,術(shù)后發(fā)生率為0.30%,翻修術(shù)骨折發(fā)生率高于初次置換術(shù),分別為13.60%、0.97%(X2=268.45,P=0.00)。初次置換術(shù)中骨折多見于DDH患者,Vancouver A2型骨折多見(19/30),翻修術(shù)中骨折多見于無菌性松動(dòng)患者,多為B3、A3型骨折(24/46；12/46)。翻修術(shù)中骨折患者有6例存在股骨畸形,骨折部位均與畸形位置一致。術(shù)后骨折患者大多數(shù)有明確的摔傷病史(12/13),骨折分型多為B型。術(shù)中骨折治療多選用鋼絲或捆綁帶,術(shù)后多選用切開復(fù)位鋼板內(nèi)固定術(shù)。初次置換術(shù)中骨折患者中,骨質(zhì)情況差者(CBR≥0.49)占66.7%。2、危險(xiǎn)因素：經(jīng)多因素分析顯示：DDH與術(shù)前CBR≥0.49為初次置換術(shù)中PFF的危險(xiǎn)因素,年齡增大為初次置換術(shù)后PFF的危險(xiǎn)因素;翻修手術(shù)前手術(shù)次數(shù)的增加、因感染翻修、術(shù)前生物型假體的使用以及股骨畸形存在會(huì)增加翻修術(shù)中PFF的發(fā)生率。翻修術(shù)亦是PFF的危險(xiǎn)因素之一。結(jié)論：PFF是髖關(guān)節(jié)置換與翻修術(shù)重要的并發(fā)癥之一,明確其危險(xiǎn)因素對(duì)該并發(fā)癥的預(yù)防有一定的指導(dǎo)意義,做好術(shù)前準(zhǔn)備、術(shù)中仔細(xì)操作、加強(qiáng)出院患者指導(dǎo)可減少骨折發(fā)生,治療依據(jù)Vancouver分型選擇內(nèi)固定或更換假體,根據(jù)骨折處理原則進(jìn)行捆綁、鋼板、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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