| Objectives and background:With the extensive popularization and popularization of hip arthroplasty and the prolongation of life expectancy,more and more advanced hip arthroplasty patients have been treated with hip replacement,and complications are emerging,including the fracture around the femoral prosthesis after hip arthroplasty,which is one of the most serious and common complications.In particular,the elderly,due to severe osteoporosis,fractures also accompanied by prosthesis loosening,the possibility of retaining the original prosthesis is fewer and less,the replacement of the new prosthesis is needed,because of the decrease of the body function of the elderly,the treatment of the fracture around the prosthesis is more complicated,the surgical trauma is larger,and the old age,which leads to the high postoperative complication rate.In order to reduce the surgical trauma and achieve the ideal clinical curative effect,it is very important to choose suitable prosthesis according to the Vancouver type and the bone condition of the femoral isthmus to renovate and treat the patients with fracture around the prosthesis.Objective of this study: 1.To investigate the effect of Vancouver B2 and B3 type prosthesis on the treatment of senile patients with complete coated long stalk prosthesis and biological group-type handle.2.Compare the incidence of complications in elderly patients after the revision of the bio-coated long handle prosthesis and the biological group-type handle.3.To explore how to choose the prosthesis for the elderly patients according to the Vancouver type and the bone condition of the femoral isthmus.Information and methods:Retrospective analysis of 32 cases of senile patients with fracture around femoral prosthesis after hip arthroplasty from September 2014 to May 2017,male 10,female 22 cases,age 65-86,average(76.3±10.0).All 32 cases were after the first joint replacement,22 cases total hip arthroplasty,10 cases of artificial femoral head replacement,biological femoral prosthesis in 29 cases,bone Cement type femoral prosthesis 3 cases,VancouverB2 type 16 cases,VancouverB3 type 16 cases,fracture time was 3-15 years after operation,average(8.0±1.5)year.According to the Vancouver classification and the cortical bone integrity of the femoral isthmus,different treatment methods were used: 14 cases of Vancouver B2-type prosthesis and 2 cases of Vancouver B3-type prosthesis fracture,Moreover,the total cortical bone of the femoral isthmus was ≥4cm in 16 patients with two types of prosthesis,and the whole-coated distal fixed long shank prosthesis was renovated + wire or bundle with ring-tie fixation;13 cases of Vancouver B3-type prosthesis and 2 cases of bone defect were not serious,but the complete cortical bone of the femur isthmus 4cm of VancouverB2 type of patient,the use of the biological group of the combination of cone-shaped prosthesis renovation,of which 8 cases with the same allograft bone plate bundle fixation,1 cases of VancouverB3-type prosthesis around the fracture patients with bone cement long handle prosthesis + steel wire or bundle with ring-tie fixed.The Harris hip score was recorded during the follow-up,and the fracture was determined by the pain and X-ray of the fracture site.Statistical analysis was carried out using SPSS22.0 software(IBM,USA).Results:All cases were followed up,followed by a period of 10-36 months and an average(24.5±0.5)month.The fracture healed,the healing time was 6-12 months,the average(8.5±0.5)month,and 8 patients who used the allograft bone plate had bone healing with the host bone.Harris hip score was increased from preoperative(4.0±1.2)to final follow-up(78.6±16.4),with statistically significant differences(t=2.82,p=0.018).Complications: 2 cases of unequal length of the lower limb,deep venous thrombosis in 2 cases.The incidence of complications was 12.5(4/32).There were no cases of thigh pain,infection around the prosthesis,aseptic loosening and further fracture during the follow-up period.Conclusion:According to Vancouver classification and comprehensive consideration of bone condition of femur isthmus,for the elderly patients with periprosthetic fracture of intact cortical bone of femoral isthmus less than 4 cm,the application of biotype combined prosthesis handle can obtain good clinical effect in early and middle stage.. |
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