Objective: To evaluate the mid-term effectiveness of cerclage wires fixation in treating Mallory typeⅡperiprosthetic femoral fractures associated with primary hip arthroplasty.
Methods: A retrospective analysis was made in the data of 14 patients (14 hips) with Mallory typeⅡ periprosthetic femoral fractures associated with primary hip arthroplasty and treated with cerclage wires fixation between January 2010 and June 2011 (fracture group). Twenty-eight patients (28 hips) without periprosthetic femoral fractures associated with primary hip arthroplasty at the same stage were chosen as control group. The uncemented femoral prosthesis were used in 2 groups. There was no significant difference in gender, age, body mass index, and primary disease between 2 groups ( P>0.05). The operation time, intraoperative blood loss, and the complications were recorded. The Harris score was used to evaluate the hip function and the visual analogue scale (VAS) score was used to evaluate the pain degree of hip. According to the postoperative X-ray films of hips, Engh et al. standard was used to evaluate the fixed and stable status of the femoral prosthesis; the heterotopic ossification was observed; the time of fracture union was recorded.
Results: The operation time of fracture group was significantly longer than that of control group ( t=-3.590， P=0.001). There was no significant difference in the intraoperative blood loss between 2 groups ( t=-1.276, P=0.209). All patients were followed up 64-75 months (mean, 69.5 months). Hip dislocation after operation occurred in 1 case of fracture group; delirium symptom and nonunion of incision occurred in 1 case and 1 case of control group, respectively. There was no significant difference in the Harris score and VAS score at 6 months and 5 years between 2 groups ( P>0.05). X-ray films showed that all fractures healed and the mean time of fracture union were 6.1 months (range, 3-12 months). There was no fracture nonunion or malunion evidently. There was no significant difference in X-ray score at 6 months and 5 years between 2 groups ( P>0.05). At last follow-up, cerclage wires displacement or breakage did not occur. Heterotopic ossification occurred in 2 cases of fracture group and in 1 case of control group.
Conclusion: Cerclage wires fixation can achieve the good mid-term effectiveness in treating Mallory typeⅡintraoprative periprosthetic femoral fractures associated with primary hip arthroplasty.
目的: 探讨钢缆环扎固定治疗初次人工髋关节置换术中 MalloryⅡ型股骨假体周围骨折的中期疗效。.
方法: 回顾分析 2010 年 1 月—2011 年 6 月于初次人工髋关节置换术中发生 Mallory Ⅱ型股骨假体周围骨折，并使用钢缆环扎固定的 14 例（14 髋）患者（骨折组）临床资料；选择同期行初次人工髋关节置换术且术中未发生骨折的 28 例（28 髋）患者作为对照组。两组患者均采用生物型股骨假体。两组患者性别、年龄、体质量指数、关节置换原因比较，差异均无统计学意义（ P>0.05）。记录两组手术时间、术中出血量以及术后并发症发生情况。采用 Harris 评分评价髋关节功能恢复情况，疼痛视觉模拟评分（VAS）评估髋关节疼痛情况。摄髋关节 X 线片，根据 Engh 等的 X 线评分标准，评价两组股骨假体固定和稳定情况；观察术后是否发生异位骨化；记录骨折组股骨骨折愈合时间。.
结果: 骨折组患者手术时间较对照组明显延长（ t=–3.590， P=0.001），但术中出血量比较差异无统计学意义（ t=–1.276， P=0.209）。术后患者均获随访，随访时间 64～75 个月，平均 69.5 个月。骨折组 1 例术后发生髋关节脱位；对照组 1 例术后发生切口不愈合，1 例发生谵妄症状。术后 6 个月及 5 年两组 Harris 评分及 VAS 评分比较，差异均无统计学意义（ P>0.05）。X 线片复查示，骨折组股骨骨折均愈合，愈合时间为 3～12 个月，平均 6.1 个月；均未见骨折不愈合或明显骨折畸形愈合。术后 6 个月及 5 年，两组 X 线评分比较差异均无统计学意义（ P>0.05）。末次随访时，骨折组未发现钢缆移动、断裂、脱落等现象。骨折组 2 例、对照组 1 例发生异位骨化。.
结论: 采用钢缆环扎固定治疗初次人工髋关节置换术中 Mallory Ⅱ型股骨假体周围骨折，可获得良好的中期疗效。.
Keywords: Hip arthroplasty; cerclage wire; femur; periprosthetic fracture.