人工髋关节置换并发假体周围骨折的临床分析

目的：分析人工髋关节置换术中、术后发生假体周围骨折的原因，探讨其预防措施和治疗方法。方法：总结自1995年7月至2006年8月总共640例人工髋关节置换术患者，其中18例发生假体周围骨折，术中骨折11例（股骨距骨折7例，假体柄下端骨折4例），术后骨折7例（假体柄下端、远端骨折），男性12例，女性6例，平均年龄68岁（51～79岁），按照髋关节假体置换术后骨折的AAOS分型Ⅰ型1例，Ⅱ型6例，Ⅲ型4例，Ⅳa型4例，Ⅳb型2例，Ⅴ型1例，Ⅵ型2例，其中术中假体周围骨折11例有10例予立即内固定，1例（Ⅱ型）股骨距劈裂骨折无明显移位未做内固定，仅延迟下地负重时问；术后假体周围骨折7例有4例在两周内行手术内固定，2例合并假体松动而采用全髋关节翻修术，1例（Ⅵ型）假体远端骨折因身体原因无法手术而采取保守治疗予以骨牵引4周后改石膏外固定。结果：术后平均随访时间15．2个月（6—42个月），15例患者骨折均达到骨性愈合，2例发生骨折延迟愈合，保守治疗的1例患者术后6个月拍片示骨折畸形愈合，术后8个月因内科疾病死亡。Harris评分平均80分（67-92分）。结论：术中暴力、股骨髓腔发育异常、假体型号过大、骨质疏松是术中假体周围骨折发生的主要原因，骨溶解、假体松动、骨质疏松加外伤是术后发生假体周围骨折的主要原因，根据不同分型采用不同的治疗方法以促进骨折愈合，稳定假体，减少卧床时间和并发症（尤其对高龄患者更为重要），尽早恢复功能。

Clinical analysis of periprothetic femoral fracture with hip arthroplasty

Objective： To analyze the causes of intraoperative and postoperative periprothetic fracture with hip arthroplasty and discuss the prevention and treatment of the fracture.Methods： 18 of 640 THR cases occurred femur fracture from July 1995 to August 2006, 11 with intraoperative fracture and 7 with postoperative fracture, 12 male and 6 female, the mean age was 68 years （range：51 to 79 years）.According to AAOS＇standard, 18 cases were divided into 6 types： 1 of I type,6 of II type,4 of III type,4 of IVa type,2 of IVb type, 1 of V type and 2 of VI type.10 of 11 cases of intraoprative fracture were operated immediately with internal fixation, and one of II type was treated with conservative method.4 of 7 cases of postopera- tive fracture were operated with open reduction and internal fixation in two weeks, 2 cases with loosened stem were operated by revision hip , and one of V type was treated with conservative method because of other disease.Results：The mean foUowed up period were 15.2 months（rang：6 to 42 months）, 15 fractures united, 2 delayed united and 1 dead after 8 months postoperatively.The average scores were 80 according to Harris＇standard （range：67 to 92）. Conclusion： Violence, abnormal of femur, canal,osteoprosis and bigger prothesis were the main causes of intraoperatively periprothetic femur fracture after THA, and loosening, osteoperosis and outside injury were the main causes of postoperatively periprothetic femur fracture. Different treatment should be used according to the different types.