人工髋关节置换术后假体柄周围股骨骨折的治疗

目的探讨人工髋关节置换术后假体柄周围股骨骨折的治疗计划以及临床效果。方法回顾自1988年1月至2001年6月本组收治的45例患者，依Vancouver分类系统，共有7例A型骨折，24例B1型骨折，7例B2型骨折，4例B3型骨折以及3例C型骨折。分别根据假体稳定度作骨折内固定或人工髋关节翻修手术，应用钢板加钢丝或钢索、Dall—Miles钢板、异体结构骨、异体骨碎片等，翻修手术应用常规骨柄或组合式股骨柄，并分析各类型骨折及各种治疗方式的结果与并发症。结果A型及B1型骨折的愈合率高，但必须注意钢板的长度；B2型骨折要注意翻修手术时的角度，避免术后出现脱臼；至于B3及C型则由于骨折复杂，并发症及失败率极高。因此，本研究提出关于这类损伤的治疗流程，让整个复杂程序更具逻辑性、简单性。结论人工髋关节置换术后假体柄周围股骨骨折是一个较复杂的问题。要获得成功的治疗，必须清楚判断骨折的特性，善用各种骨折治疗材料，以一个逻辑性思考做术前治疗计划，因此适当的分类系统显得特别重要。

Treatment of periprosthetic femoral fractures following hip arthroplasty

Objective To discuss an accuracy preoperative planning and clinical effects according to the periprosthetic femoral fracture following hip arthroplasty.Methods We retrospectively review 45 periporsthetic femoral fracture treated at Taichung Veteran General Hospital from Jan 1988 to Jun 2001.Results data include the medical record and X-ray film. The patient were classified by Vancouver classification. There were 7 type A, 24 type B1, 7 type B2, 4 type B3, and 3 type C cases. The option of treatments including open reduction with internal fixation or revision total hip arthroplasty with or without wire, cable, Dall-Miles plate, structural allograft or chips of allogenous bone graft. The prosthesis used in revision THR are long stem prosthesis or modular type stem. Results Type A and B1 have high union rate, though we must be careful to the length of the plate. The alignment of revision surgery is the key point of the treatment of type B2. In complicated type B3 and C, high failure rate was noted. We analysis the results and complication of the methods used in treating each type of fracture. Construct an algorithm for treating the complicated injury making it more logically and simple.Conclusions Treatment of Periprosthetic Femoral Fractures Following Hip Arthroplasty is a complicated issue. Clearly read the personality of the fracture, familiar all options of treatment, properly select a method, and construct a logically treatment flow chart, are the criteria for successful treatment.