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1.
Trapezoidal-28 total hip replacement   总被引:1,自引:0,他引:1  
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Seven different reduction techniques have been tested in the treatment of displaced femoral neck fractures using the fracture table. Wellmerling's technique is preferred because of its utility, predictable results, and flexibility in treatment alternatives.  相似文献   

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From 1970 to March 1978, 716 forged stainless steel Trapezoidal-28 (T-28) total hip arthroplasties were performed at the authors' institution with a follow-up period from one to 15 years (mean, 64 months). There were 13 (1.8%) stem fractures and one (0.1%) neck fracture. Average time to fracture was 95 months. All fractures occurred in stems implanted before 1976, using early femoral acrylic stem fixation techniques. Stem fracture was related to time of surgery, stem size, patient height, patient weight (for males), and patient age. Survivorship analysis predicted an overall ten-year fracture rate of 4%, and a ten-year rate of 5% for T-28 stems implanted before 1976. There have been no reported fractures in the 204 T-28 stainless steel prostheses implanted since 1976. The mean patient follow-up period for the T-28 stems implanted after 1975 was 52 months, and only 16 patients have been followed for nine years or more. Thus, a longer patient follow-up period is needed in the post-1975 group in order to determine the long-term fracture rate in this group. However, the major difference between this group and the early group is the use of an improved cementation technique, as well as the use of larger prostheses when possible. There was no material or manufacturing change until the introduction of the TR-28 prostheses in 1978.  相似文献   

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空心加压螺纹钉治疗新鲜股骨颈骨折28例   总被引:2,自引:1,他引:2  
2001年3月-2002年3月,我科应用空心加压螺纹钉内固定治疗老年新鲜股骨颈骨折28例,疗效满意。  相似文献   

7.
Revision total hip arthroplasty in the setting of a large proximal femoral deficiency or a peri-prosthetic fracture remains a challenging problem. We describe the development, surgical technique and the use of cementless revision stems with distal inter-locking screws to provide immediate stability of the femoral implant. Results were assessed in a large multicentre French study conducted with the french hip and knee surgery society (SFHG). We retrospectively reviewed 725 revisions using interlocking stems from 14 French orthopaedic departments. Seven different stems were used in this series. In-patient records were retrieved, and in addition to demographic data the indication for revision, the preoperative and postoperative PMA and Harris hip scores were documented. The bone deficiency was classified on the basis of the French National Orthopaedic Meeting (SOFCOT) classification. Intraoperative complications and problems if any were retrieved from operative notes. Clinical status and radiographs at the final follow-up were evaluated, paying special attention to the metaphyseal filling index. Average follow-up was 4.5 years. As for the clinical results, the mean Harris hip score at last follow-up was 81. Therefore, it increased by an average of 31 points. Bone reconstruction was assessed on the cortico-medullary index in the metaphyseal area and at mid-shaft increasing from 36 to 45 and 54 to 63, respectively. Radiologically, 637 implants were stable, and 40 demonstrated subsidence. Forty-eight implants have been revised. We found a significant relation between the metaphyseal filling index, the stability of the stem and the quality of bone reconstruction. Results were analysed with respect to three groups of stems: group 1 was a straight, partially HA-coated implant; group 2 was a curved, fully HA-coated implant; and group 3 was a curved, partially-coated implant. Group 1 showed a significantly higher rate of failure when compared with the others types of implants. Group 2 had better functional results than group 3, which in turn reported better results than group 1. With regard to implant fixation, group 2 had significantly better results. Both groups 2 and 3 induced less thigh pain than group 1. The distal interlocking stem has shown promising results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony in-growth owing to hydroxyapatite coating. Distal locked stems are mainly indicated to treat complex femoral revision with severe bone loss and peri-prosthetic fractures.  相似文献   

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The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.  相似文献   

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Summary. Fractures around a femoral prosthesis have been treated with plating and additional cement, but this leads to further reduction of bone stock in the proximal femur. Since February 1992, we have dealt with this problem in 12 patients by revision using a long uncemented stem and distal interlocking combined with homologous bone grafting. Bony ingrowth and remodelling led to restoration of the proximal femur. After bone healing, removal of the distal interlocking screws converts the distal load transfer to the proximal anchoring of the revision stem so that osteointegration can occur in the trochanteric region. The clinical results were good in all the patients after a mean follow up of 23.5 months. This is a method which provides biological osteosynthesis and is especially indicated in younger patients.
Résumé. Les fractures fémorales périprothétiques constituent en chirurgie orthopédique un problème majeur. Les traitements conventionnels, pose d’une plaque et/ou de ciment, accentuent la diminution de la masse osseuse dans le fémur proximal. Une méthode de conception différente a été employée chez 12 sujets depuis février 1992. Cette intervention de reprise sans utilisation de ciment consiste à implanter une longue tige de reprise avec un verrouillage distal pour la stabilité initiale et une allogreffe osseuse. La formation et le remodelage osseux ont permis une excellente restauration du fémur proximal. L’ablation des vis distales (dynamisation) après remodelage de l’os convertit le transfert distal de charges en ancrage proximal de la tige de reprise et favorise l’Osteointegration dans la région intertrochanterienne. De bons résultats cliniques ont été obtenus chez tous les sujets au terme d’une période de suivi de 6 à 39 mois (23,5 mois en moyenne). La reprise prothétique sans utilisation de ciment, avec greffe osseuse et dynamisation, est considérée comme une ostéosynthèse biologique convenant surtout aux sujets assez jeunes.


Accepted: 21 April 1996  相似文献   

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PURPOSE: To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. METHODS: 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. RESULTS: Patients were followed up for a mean of 14 (range, 8-18) years. The mean Harris hip score improved from 29 (range, 5-40) to 78 (range, 56-88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6-14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. CONCLUSION: Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.  相似文献   

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骨水泥型长柄人工股骨头假体治疗老年股骨转子间骨折   总被引:1,自引:1,他引:0  
2004年7月~2007年9月,我院采用骨水泥型长柄人工股骨头假体治疗高龄老年不稳定型股骨转子间骨折19例,取得了良好的疗效。  相似文献   

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OBJECTIVES: To measure the effect of an impaction fracture of the femoral head on load transmission in the hip joint. DESIGN: We measured the contact areas and pressure between the acetabulum and femoral head of cadaveric pelves in four different conditions: intact, with an operatively created one-square-centimeter defect in the superior femoral head, with a two-square-centimeter defect, and with a four-square-centimeter defect. All defects were uniformly three millimeters deep. SETTING: Hips were loaded in a simulated single-limb stance. Pressure and area measurements were made with Fuji pressure-sensitive film. SPECIMENS: Seven hip joints in seven whole pelves were tested. MAIN OUTCOME MEASUREMENTS: Contact area, load, and mean and maximum pressures were measured. RESULTS: Peripheral loading was seen in the intact acetabulum. This was not disrupted after impaction fractures of any size. A significant increase in mean maximum pressures in the superior acetabulum was seen with two-square-centimeter and four-square-centimeter defects. CONCLUSIONS: In contrast to prior biomechanical studies of acetabular fractures, our investigation revealed that disruption of the peripheral distribution of load does not occur with impaction fractures of the femoral head. Clinical series indicate that impaction injuries to the femoral head are associated with a poor prognosis. Previous biomechanical data on acetabular fracture patterns associated with a poor prognosis have shown increases in mean and peak pressures in the superior acetabulum. This was seen with two-square-centimeter and four-square-centimeter impaction injuries. Other factors, such as wear of the articular cartilage during joint motion or associated microscopic damage to the remainder of the joint surface at the time of injury, may also contribute to the rapid joint deterioration seen in these injuries. Further study is indicated.  相似文献   

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开放性股骨髁上骨折28例手术治疗临床分析   总被引:2,自引:0,他引:2  
目的回顾性分析开放性股骨髁上骨折治疗的临床资料,评价其治疗效果。方法对28例开放性股骨髁上骨折术中彻底清创,Anderson-GustiloⅠ型骨折采用内固定治疗;Anderson-GustiloⅡ、ⅢA型骨折视软组织情况,采用内固定或外固定架固定;Anderson-GustiloⅢB、C型骨折均采用外固定架固定治疗。一期或延迟封闭创面。结果 28例获6~24个月(平均12.7个月)随访。3例发生浅表感染,无骨髓炎发生,2例因骨折不愈合再次行手术治疗,3例发生创伤性膝关节炎。末次随访时膝关节Merchant评分:优10例,良14例,可3例,差1例,优良率85.7%。结论开放性股骨髁上骨折损伤重、处理难度大,选择合适的固定方式、正确处理骨折及软组织损伤、减少感染等并发症的发生是治疗的关键。  相似文献   

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同侧股骨干合并股骨颈骨折的处理   总被引:17,自引:11,他引:6  
目的 分析同侧股骨干合并股骨颈骨折的临床特点和诊断要点,探讨不同治疗方法的疗效。方法 1998年3月-2001年6月收治的18例19个同侧股骨干合并股骨颈骨折病人中,早期诊断12例,2例用多针固定。2例行缝匠肌带肌蒂植骨,3例行带旋髂深血管植骨术。结果 术后随访8-40个月,平均16个月。股骨干骨折除1例钢板固定不愈合外其余均愈合。股骨颈骨折1例不愈合,其余均愈合。结论 对股骨干骨折合并同侧股骨颈骨折早期推荐使用逆行带锁髓内钉和空心螺钉固定,对漏诊病例使用多针在股骨髓内钉前方固定股骨颈是一种有效的补救方法,晚期漏诊采用带肌蒂、血管蒂植骨术仍可取得较高愈合率。  相似文献   

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股骨转子周围骨折并股骨中上段骨折的手术治疗   总被引:4,自引:1,他引:4  
[目的]探讨应用股骨近端髓内钉配合有限切开复位钛捆绑带内固定治疗股骨转子周围骨折并股骨中上段骨折的手术方法和疗效。[方法]对2002年1月~2006年10月收治的21例股骨转子周围骨折并股骨中上段骨折的病人,均采用股骨近端髓内钉固定或配合行有限切开复位钛捆绑带内固定技术治疗。[结果]21例病人全部获得9个月~5年的随访,平均13个月,所有病例均达临床骨性愈合,未出现内固定物折断、松动、脱出等情况。患肢髋膝关节功能均恢复良好。[结论]根据病人的年龄和骨折的类型,采用股骨近端髓内钉或配合行有限切开复位钛捆绑带内固定技术是一种良好的内固定方式,具有创伤小、操作简便易行、固定牢固可靠、利于骨折愈合等优点,良好的保留了患肢的功能。技术的主要关键是在微创的前提下达到解剖复位。  相似文献   

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Subtrochanteric-intertrochanteric femoral fractures   总被引:2,自引:0,他引:2  
Subtrochanteric fractures can be managed effectively with newer techniques and implants. If the proximal fragment is intact and includes the lesser trochanter, an interlocking intramedullary nail is indicated. If there is inter-subtrochanteric comminution, a screw-plate device with bone graft, or a Zickel nail should be used.  相似文献   

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Distal femoral fractures   总被引:2,自引:0,他引:2  
Distal femoral fractures largely occur secondary to high-energy trauma in the younger population and as osteoporotic fractures in the elderly population, including periprosthetic fractures above a TKA. Attempts to gain satisfactory axial alignment, articular congruity, and knee range of motion with conservative treatment have been largely disappointing. Operative fixation options include open reduction and internal fixation, intramedullary nailing, and bridge plating or percutaneous submuscular plating techniques. As with any fracture, treatment choice must be individualized according to the nature of the injury, bone quality, and patient demand. Regardless of treatment method, goals include restoration of articular congruity, anatomical length, rotation, and axial alignment while establishing adequate fixation to initiate early and unrestricted range of motion.  相似文献   

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