髋关节置换术中股骨骨折的处理与相关危险因素分析

目的 分析髋关节置换术中股骨骨折的危险因素并探讨其处理方法.方法 对我科2002年11月-2009年11月收治的38例髋关节置换术中发生股骨骨折的患者资料进行回顾性分析.骨折分类按照Amstutz分型或美国骨科医师协会(AAOS)分型,并据此选择治疗方法.25例予术中内固定,包括14例单纯捆绑固定,5例钢板固定和6例大段异体骨结合钢丝捆绑带捆扎固定.有12例更换长柄假体.结果 平均随访4.5年(0.5～7.5年),有36例正常愈合,2例延迟愈合,有1例4年后假体柄松动需要翻修.结论 骨质疏松、术中暴力、髓腔发育异常和假体型号过大是术中股骨骨折的主要原因.按照骨折分型选择适当的治疗方法多能取得满意的临床效果.

Risk factors and treatment of intraoperative femur fracture in hip replacement

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.