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～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岁傅1～79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例子立即内固定,1例（Ⅱ型）股骨距劈裂骨折无明显移位未做内固定,仅延迟下地负重时间;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,l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1。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。     

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。     

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...     

人工髋关节置换术中股骨假体周围骨折的防治

人工髋关节置换治疗股骨颈骨折及病变髋关节日益普及，并逐渐走向成熟，手术指征较以前有所放宽。但并发症随之日见突出。避免人工髋关节置换手术中的失误是减少术后并发症的关键，提高手术质量及疗效是医患双方均关心的问题。我们回顾2000年1月～2003年12月共行初次人工髋关节置换127例，对其中7例出现股骨假体周围骨折的并发症作总结分析。     

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.     

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。     

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。     

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.     

髋关节置换术后股骨假体周围骨折的分型

股骨假体周围骨折系髋关节置换术后严重的并发症之一，据文献报道骨水泥型股骨假体周围骨折发生率为0．1％～3．2％，非骨水泥型发生率为4．1％～27．8％，翻修术后发生率为4％～20％。近年来，随着髋关节置换术的增加及患者年龄的增高，股骨假体周围骨折的发生率也在不断增高。对此类骨折进行合理的分型，将有助于治疗方法的选择与疗效的预测。     

锁定加压钢板合并捆扎带治疗股骨假体周围骨折

目的探讨捆扎带合并锁定加压钢板固定治疗股骨假体周围骨折的临床效果。方法对7例股骨假体周围骨折进行切开复位,锁定加压钢板固定,在含有假体的股骨近折端用锁定螺钉作单侧骨皮质固定,不含假体的股骨远折端作双侧骨皮质螺钉固定,同时在包含假体的骨折端两侧利用捆扎带将股骨及钢板同时捆扎固定,自体骨或异体骨植骨。对假体不稳的患者在骨折复位后行假体翻修术。结果术后患者可早期起床运动：随访5个月～3年,骨折未见移位,7例假体周围骨折均获得愈合,髋关节功能得到恢复。假体未见松动。结论股骨假体周围骨折大多为长螺旋型骨折,捆扎带合并锁定加压钢板治疗股骨假体周围骨折简单有效,固定效果确切,根据骨缺损情况辅以植骨,可获得良好的临床效果。     

Central fracture dislocation of the hip associated with fracture of femoral neck treated by femoral head autograft and total hip arthroplasty: A rare case report

Central Fracture Dislocation of the Hip is a rare condition requiring more attention in its management, caused by high-energy trauma and is often associated with other injuries. This case report presents a 57-years old female who was injured in a traffic accident and diagnosed with polytrauma, abdominal blunt trauma with 7th zone liver laceration, central fracture dislocation of the left hip associated with closed fracture left acetabulum anterior column and closed fracture left neck femur. Until now, there is no mandatory management to treat this kind of injury. Several surgical techniques were explained in previous literatures to treat this condition such as Open Reduction and Internal Fixation (ORIF) procedure and Total Hip Arthroplasty (THA). Some studies chose THA as a treatment for similar condition in older population due to high risk of nonunion and avascular necrosis of the femoral head, especially in cases of significant displacement and devitalization of the femoral head. In this case, we performed femoral head autograft and total hip arthroplasty as a definitive treatment.     

人工全髋关节置换术治疗老年股骨颈骨折

目的探讨人工全髋关节置换术治疗老年股骨颈骨折的临床疗效。方法对52例应用人工全髋关节置换术治疗老年股骨颈骨折患者临床资料进行回顾性分析,并对骨水泥固定16例与未用骨水泥固定18例的临床疗效进行比较。结果随访时间1-10年,平均5年6个月。根据Harris髋关节评分标准,骨水泥组疗效：优11例,良8例,尚可4例,差2例;非骨水泥组疗效：优11例,良10例,尚可5例,差1例。结论人工全髋关节置换术是老年股骨颈骨折的理想治疗方法．府用骨水泥固定与非骨水泥方法．两者疗效并无显著善异．     

Fracture of the femoral head after ceramic-on-polyethylene total hip arthroplasty

Four of 184 ceramic femoral heads that the authors used in total hip arthroplasty fractured from 5 to 9 months after surgery. A polyethylene-lined acetabular component was used in all cases. The fracture rate, 2.2%, was much higher than previously reported for ceramic head fractures when used with a polyethylene cup. The fractures occurred during normal daily activities. Possible causes included manufacturing defects, neck length (short in all cases), bearing diameter (28 mm in all cases), cone-trunnion mismatch, excess hoop stresses from impaction, or material deterioration. All patients were treated by removal of debris, wide excision of capsular tissue containing tiny abrasive fragments, exchange of the modular polyethylene liner, and implantation of a cobalt—chrome femoral head. The trunnion had been somewhat damaged by relatively brief exposure to the ceramic particles in every case. The authors' experience suggests that ceramic femoral heads be used with caution.     

Total hip arthroplasty for femoral neck fracture with pyoderma gangrenosum patient: A case report

IntroductionPyoderma gangrenosum is a rare inflammatory aseptic, ulcerative neutrophilic dermatosis which manifest as skin recurrent, painful ulcers.Presentation of caseA 65-year-old man with pyoderma gangrenosum underwent left total hip arthroplasty because of femoral neck fractures. Glucocorticoid, antibiotic, anticoagulant drug, etc. were given in perioperative period. Complication of pyoderma gangrenosum was prevented successfully in perioperative period.DiscussionNo consensus has been reached about whether to use glucocorticoid, as well as the dosage and administration, in perioperative periods for pyoderma gangrenosum patients as prophylactic means of wound complication.ConclusionWe herein report a case of pyoderma gangrenosum patient underwent total hip arthroplasty, meanwhile raise the issue of management in perioperative period for pyoderma gangrenosum patient, especially explore series of standardized therapies for this disease during arthroplasty.     

Alumina femoral head fracture in uncemented total hip arthroplasty with a ceramic sandwich cup

In total hip arthroplasty, insertion of a UHMWPE-coated ceramic sandwich liner dramatically reduces any risk related to the stiffness of the ceramic-ceramic coupling. We present a case of an alumina ceramic head fracture with a ceramic sandwich cup. The fracture occurred 16 months after the initial operation, without trauma. Impingement between the neck and posteroinferior portion of the liner rim had occurred. This was related to the traditional cross-legged sitting position of Koreans, which caused impingement between the neck and liner rim. Consequently, the taper became loose, and the resulting force bent the taper and fractured the head. We examined a peculiar case of ceramic femoral head fracture after implantation of an uncemented total hip arthroplasty with a ceramic sandwich cup and investigated the underlying cause.     

Treatment of periprosthetic femoral fracture after cementless total hip arthroplasty with Ilizarov external fixation

A 72-year-old woman with periprosthetic femoral fracture after cementless total hip arthroplasty (THA) underwent external fixation using the Ilizarov method. Although open reduction and internal fixation with a condylar plate system were initially attempted, deep infection with methicillin-resistant Staphylococcus aureus at the fracture site occurred 2 weeks postoperatively. Six weeks after removal of the plating system, the fracture was stabilized with external fixation using the Ilizarov method and went on to successful fusion at 3 months. To our knowledge, this is the first report in which Ilizarov external fixation has been used for periprosthetic femoral fracture after THA. Although this is a rare situation, where periprosthetic fracture and infection coexist, Ilizarov external fixation is a safe and reliable method for periprosthetic femoral fracture with infection.     

Periprosthetic femoral fracture after total hip arthroplast

Periprosthetic femoral fractures represent a significant complication in total hip arthroplasty. based on originand treatment considerations, these fractures are best considered on the basis of the proximal region, and middle region below the lesser trochanter, and distal region at the prosthetic tip and beyond. Proximal-region fractures are usually wired and treated conservatively. Middle-region fractures may require prosthetic revision in addition to fracture fixation.Distal-region fractures are most difficult and may need advanced techniques, such as distal prosthetic fixation and allograft femoral plates.