全髋关节置换术后股骨假体周围骨折的治疗

目的：分析全髋关节置换术后股骨假体周围骨折的病因和治疗结果．探讨其治疗方法。方法：回顾性研究自1998年12月-2003年3月治疗并随访观察的11例全髋关节置换术后股骨假体周围骨折患者，男8例，女3例，平均年龄为56岁(43-75岁)，采用Vancouver分型，A型2例，B2型7例．B3型1例，C型1例。采用非手术治疗5例；手术治疗6例，其中1例为非手术治疗后骨折畸形愈合行翻修术。采用长柄假体翻修联合异体皮质骨板固定5例．其中使用非骨水泥型远端固定假体4例．使用骨水泥型假体1例。采用切开复位内固定治疗1例。结果：所有病例均获随访，平均随访25．6个月(7～50个月)。9例骨折愈合，平均愈合时间4个月(3-6个月)，2例骨折未愈合。均为非手术治疗病例，手术治疗6例骨折均愈合。至目前为止，7例假体稳定，1例翻修术后出现连续的影像学透亮线．3例假体松动，假体稳定的患者功能好于假体松动者．假体稳定患者的Harris评分平均91分。所有异体皮质骨板在1年内均与宿主骨整台．没有异体皮质骨板骨折发生。结论：假体稳定的A型骨折可以采用非手术治疗。对于B1型和C型骨折，如无手术禁忌证，应行切开复位内固定术。对于假体松动的骨折患者，使用长柄远端固定非骨水混型假体联合异体皮质骨板是最佳的治疗方法。     

全髋关节置换术后股骨假体周围骨折研究进展

全髋关节置换术后股骨假体周围骨折的发生率近年来不断增加,已成为继假体松动和复发性脱位之后导致髋关节翻修的第3位最常见原因。股骨假体周围骨折治疗难度大,手术失败率高,有一定致死率。认识并避免导致股骨假体周围骨折的危险因素,正确掌握各类型骨折的治疗原则,准确判断股骨假体的稳定性,并选择适当的内固定或翻修方法,是获得可靠治疗疗效的保证。     

人工全髋关节置换术后股骨假体周围骨折的治疗进展

随着人工全髋关节置换术(total hip arthroplasty,THA)增多以及老年人平均寿命增加,THA术后股骨假体周围骨折(periprosthetic femoral fractures,PFF)的发生率逐渐增加,累积的绝对数量也在逐年增加,并被认为是髋关节置换术后的一个重要并发症。股骨假体周围骨折处理难度比较大,     

全髋关节术后假体周围骨折治疗进展

全髋关节置换术后股骨假体周围骨折是临床上颇具挑战性的难题,已成为继假体松动和复发性脱位之后导致髋关节翻修的第3位最常见原因。股骨假体周围骨折治疗难度大,手术失败率高,且有一定的致死率。正确认识并避免导致股骨假体周围骨折的危险因素,掌握股骨假体周围的Vancouver分型及各类型骨折的治疗原则,是获得可靠疗效的保证。     

人工髋关节置换术后股骨假体周围骨折的治疗

目的 探讨人工髋关节置换术后股骨假体周围骨折的治疗方法及临床效果.方法 采用温哥华术后骨折分型标准,共收治人工髋关节置换术后股骨假体周围骨折13例.结果 13例均获得随访,随访时髋关节功能按Harris评分:优4例,良5例,中3例,差1例.其中1例不愈合,其余12例获骨性愈合.结论 对此类骨折应根据近期影像资料进行周密的术前计划,结合骨折部位、假体稳定性及骨储备情况等因素,选择治疗方案.使用钢丝环扎、非骨水泥型长柄翻修联合应用异体皮质骨板及局部植骨是处理不同类型股骨假体周围骨折的有效治疗方法.     

髋关节置换术中假体周围骨折12例报告

目的 分析髋关节置换术中并发假体周围骨折的原因及防治措施.方法 自1999年5月～2010年9月,笔者施行人工髋关节置换术385例,共12例发生术中假体周围骨折,其中全髋关节置换术7例,髋关节翻修术4例,股骨头置换1例.全部病例术中均同期内固定.结果 11例获得随访,平均随访时间17.3个月(9～28个月),骨折均骨性...     

人工髋关节置换术后股骨假体周围骨折的治疗体会

目的总结人工髋关节置换术后股骨假体周围骨折治疗的经验和体会。方法 2002年1月至2008年1月治疗人工髋关节置换术后股骨假体周围骨折的患者21例,19例患者采用手术治疗,按照Vancouver分型标准进行分类,选择不同的手术方式进行治疗,包括：锁定加压接骨板固定,钢缆固定,同时结合异体骨板固定,关节翻修术等。结果术后随访2～6年,平均5年,所有患者骨折均获得骨性愈合,骨折平均愈合时间为6个月（4～9个月）,在最后随访时均有比较好的髋关节功能,Harris评分平均86分（78～92分）。结论按照股骨假体周围骨折的类型,选用合适的治疗方法,全面术前计划,可以取得比较满意的治疗效果。     

锁定接骨板内固定治疗全髋关节置换术后假体周围骨折

2007年2月-2013年2月,我科应用锁定接骨板治疗21例全髋关节置换术后股骨假体周围骨折Vancouver B型患者,获得较好的效果,报道如下.     

全髋关节置换术后股骨假体周围骨折治疗进展

全髋关节置换术(THA)后股骨假体周围骨折是临床上颇具挑战性的难题。Vancouver分型涉及股骨假体周围骨折位置及稳定性、假体松动情况、股骨近端骨量等,是临床上应用较多的分型方法。伴有假体松动的Vancouver B2型和B3型骨折占50%以上,因此预防和治疗THA后假体松动和(或)骨溶解很重要。针对股骨假体周围骨折内固定的生物力学研究等已成为热点,伴感染的股骨假体周围骨折、股骨假体周围多次骨折以及内固定失败的防治也见诸报道。该文就股骨假体周围骨折的治疗及预防措施的研究进展作一综述。     

老年髋关节置换术后假体周围骨折治疗临床观察

目的 研究髋关节置换术后假体周围骨折治疗方法的选择.方法 髋关节置换术后假体周围骨折11例,5例采用锁定钢板内固定术,2例采用钢丝环扎内固定术,2例采用钛缆环扎内固定术,非手术治疗2例.结果 1例失访,10例得到随访,平均时间12个月.Harris评分平均80分,骨折均愈合.结论 老年髋关节假体周围骨折应该采取个体化治疗原则,力求达到稳定固定.     

Femoral revision for periprosthetic fracture in total hip arthroplasty

Periprosthetic fracture can create significant morbidity in the arthroplasty population. Patients with periprosthetic fracture have been shown to have worse outcomes and higher mortality than patients undergoing elective revision THA. In this review, we will focus on Vancouver B2 and B3 fractures. Both of these fracture types are associated with a loose primary prosthesis and warrant revision surgery. There are many different options for fixation choice of the femoral prosthesis, and preference has been evolving over the last 30 years. Currently, we use monoblock, tapered, fluted, titanium stems for all periprosthetic fracture revision surgeries.     

Patient factors predict periprosthetic fractures after revision total hip arthroplasty

We assessed important patient risk factors for postoperative periprosthetic fractures after revision total hip arthroplasty (THA) using prospectively collected Institutional Joint Registry data. We used univariate and multivariable-adjusted Cox regression analyses. There were 330 postoperative periprosthetic fractures after 6281 revision THAs. In multivariable-adjusted analyses, hazard ratio (95% confidence interval) of periprosthetic fracture was higher for women (1.66 [1.32-2.080], P < .001), a higher Deyo-Charlson comorbidity index of 2 (1.46 [1.03-2.07]) and index of 3+ (2.01 [1.48-2.73]; overall, P < .001), and operative diagnosis, especially previous nonunion (5.76 [2.55-13.02]; overall, P < .001). Hazard ratio was lower in patients 61 to 70 years old (0.64 [0.49-0.84]) and 71 to 80 years old (0.57 [0.43-0.76]) compared with those younger than 60 years (overall, P < .0001). Our study identified important modifiable and unmodifiable risk factors for fractures after revision THA.     

Locking compression plate versus revision-prosthesis for Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty

IntroductionRevision arthroplasty is currently the recommended treatment for periprosthetic femoral fractures after primary total hip arthroplasty (THA) and stem loosening (Vancouver B2). However, open reduction and internal fixation (ORIF) utilizing locking compression plate (LCP) might be an effective treatment with a reduced surgical time and less complex procedure in a typically elderly patient collective with multiple comorbidities. The purpose of this study was to compare the functional and radiographic outcomes in two cohorts with Vancouver B2 periprosthetic femoral fractures after primary THA, treated either by ORIF with LCP fixation, or by revision arthroplasty utilizing a non-cemented long femoral stem.Materials and Methods36 patients with Vancouver B2 periprosthetic femoral fractures following THA, who had been treated between 2000 and 2014, were reviewed. Eight fractures were treated with LCP fixation, fourteen fractures with the first-generation revision prosthesis (Helios^®), and fourteen fractures with the second-generation revision prosthesis (Hyperion™). The patients were assessed clinically with the Parker mobility score and radiographically.ResultsA total of ten males and 26 females formed the basis of this report with an average age of 81years (range, 64 to 96 years). All fractures treated with LCP fixation alone healed uneventfully and there were no signs of secondary stem migration, malalignement or plate breakage. The average surgical time was shorter in the ORIF cohort; however, the results were not statistically significant. The postoperative Parker mobility score at latest follow-up showed no difference between the groups.ConclusionsAccording to the results of the current study, we conclude that the use of LCP fixation can be a sufficient option for the treatment of Vancouver B2 periprosthetic femoral fractures correspondingly with femoral stem loosening.     

Impaction bone grafting for periprosthetic fractures around a total hip arthroplasty

The incidence of periprosthetic fractures has been reported to be between 1 and 20.9% and appears to be on the rise. Fractures that occur around the femoral stem, particularly when the stem is loose or there is a loss of bone stock pose a technical challenge. These are rare injuries and there is considerable debate regarding their optimal treatment. Reconstruction with large segment endoprosthetic replacement is an acceptable solution for elderly patients who have limited functional demands and where the prosthesis is expected to outlive the patient. The younger patient poses a much greater challenge, the bone must be reconstituted and the femoral canal geometry must sufficiently restored to allow the stable insertion of a prosthesis. There are very few techniques that exist in this scenario. One such technique is impaction bone grafting and revision to a long smooth tapered cemented stem. This allows the restoration of bone stock and the stable insertion of a prosthesis. The aim of this article is to discuss the theory behind impaction bone grafting, the technical aspects and challenges of this technique, including fracture reduction methods, and to appraise all the literature available on impaction bone grafting for periprosthetic fractures.     

全髋与半髋关节置换术治疗老年人股骨颈骨折结果比较

目的 比较全髋关节置换术与半髋关节置换术治疗老年人完全移位股骨颈骨折的疗效。方法 将1995～2001年在我院治疗的262例60岁以上有移位的股骨颈骨折患者分为两组，A组为全髋关节置换术，B组为人工股骨头置换术。随访12～78个月，平均37个月。结果 按Harris评分标准，A组术后优良率达到93.8％；B组术后优良率达78.4％，单极与双极股骨头置换组之间结果没有明显的差别；人工股骨头置换后有5例需行全髋翻修手术；双极人工股骨头置换中有2例发生双极之间脱位，7例出现假体周围骨溶解。结论 人工股骨头或全髋关节置换术是治疗老年股骨颈骨折的有效方法，可提高老年人的生活质量，减少并发症。全髋关节置换结果优于人工股骨头置换。     

全髋关节置换术的软组织平衡

目的探讨THA术后股骨偏心距恢复的重要性及重建方法,恢复髋关节的软组织平衡。方法对73例单侧THA术患者进行随访,手术均采用髋关节后外侧入路。X线片上测量股骨偏心距及髋外展肌的力臂,使用Cybex测量髋外展肌力量,对X线片测量数据进行统计学处理。结果股骨偏心距是否能够重建与髋最大外展肌肌力存在显著性差别(t=3.859;P=0.002);髋关节外展活动范围与股骨偏心距存在明显回归相关关系(r=0.593,P<0.001)。结论THA术中重建股骨偏心距可以增加髋外展肌的力臂,改善髋外展肌的力量,增强髋关节的稳定性。术中应选用近似解剖颈干角的股骨柄假体,适当地增加假体颈的长度。     

膝关节假体周围骨折的诊断与治疗

人工膝关节置换术后假体周围骨折的发病率不断增加,该疾病的治疗是临床工作中的难题,具有挑战性,治疗方法分为保守治疗和手术治疗.只有对假体周围骨折有充分系统的认识以及在实施治疗前考虑到具体治疗方法的优缺点,才能取得良好的疗效.本文就近年来对膝关节假体周围骨折的分型、治疗方法和疗效的研究进展做以综述.     

Outcomes of fixation for periprosthetic tibia fractures around and below total knee arthroplasty

IntroductionThe incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to an increasing number of TKAs performed annually and the growing elderly population. Like periprosthetic fractures of the distal femur, periprosthetic tibia fractures are primarily treated with operative fixation; however, there is limited scientific literature that has reported outcomes of periprosthetic tibia fractures treated with modern plating techniques. To our knowledge, this is the largest series of non-intraoperative periprosthetic tibia fractures treated with open reduction internal fixation (ORIF) ever reported.MethodsRetrospective chart review of 4557 operatively treated tibia fractures with ORIF over a 16-year period at two Level 1 Trauma Centers.Results38 patients with an average follow-up of 15.3 months (range 3–24) were identified. 11 (28.9%) fractures were in the proximal tibia (four with extension into the plateau (Felix 1A) and seven adjacent to the tibial stem (Felix 2A)), six (15.8%) in the midshaft/diaphysis (Felix 3A), and 21 (55.3%) in the distal 1/3rd (metaphysis, Felix 3A). 76.3% (29/38) of fractures united by 6 months following the index procedure, leaving 9 nonunions. The overall re-operation rate was 31.6% (12/38). There were no significant differences in rates of union (p = 1.00), reoperation (p = 0.66), superficial infection (p = 0.66), or deep infection (p = 0.31) in patients treated with single versus dual plating.ConclusionPeriprosthetic tibia fractures are difficult to treat and have a high risk of nonunion and reoperation even with modern plating techniques. Most patients can be treated to union with operative fixation and do not require revision arthroplasty, if the components are stable initially. We recommend dual plating for fractures in the proximal third, and either single plating or nailing for fractures in the middle and distal thirds depending on bone quality, implant positioning, and fracture morphology.     

Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report

IntroductionPeriprosthetic fractures around the knee after total knee arthroplasty can be seen in the femur, tibia and patella. The tibial fractures are rare cases. Our case with bilateral tibial stress fracture developed after total knee arthroplasty (TKA) is the first of its kind in the literature.Presentation of case75-year-old male patient with bilateral knee osteoarthritis had not benefited from conservative treatment methods previously applied. Left TKA was applied. In the second month postoperatively, periprosthetic tibial fracture was identified and osteosynthesis was implemented with locked tibia proximal plate-screw. Bone union in 12 weeks was observed in his follow-ups.After 15 months of his first operation, TKA was applied to the right knee. Postoperatively in the second month, as in the first operation, periprosthetic tibial fracture was detected. Osteosynthesis with locking plate-screw was applied and union in 12 weeks was observed in his follow-up.He was seen mobilized independently and without support in the last control of the case made in the 24th month after the second operation.DiscussionThe number of TKA applications is expected to increase in the future. The incidence of periprosthetic fractures should also be expected to increase in these cases. Periprosthetic tibial fractures after TKA are rarely seen. The treatment of periprosthetic fractures around the knee after TKA can be difficult.ConclusionIn the case of persistent pain in the upper end of the tibia after the surgery, stress fracture should be considered.