髋关节置换后股骨假体柄周围骨折9例

背景：髋关节置换后股骨假体周围骨折因金属假体存在、局部骨质质量下降，治疗难度大，治疗方式选择存在诸多争议。 目的：总结髋关节置换后股骨假体柄周围骨折治疗方式的选择及相应临床治疗效果。 方法：回顾性分析新疆石河子大学医学院第一附属医院骨一科2001-02/2009-06收治的9例股骨假体柄周围骨折患者，依据Vancouver骨折分型，A型骨折1例，B1型骨折3例，B2型骨折4例，C型骨折1例。分别采用保守治疗、钢丝环扎、长柄翻修术结合钢丝环扎和钢板内固定治疗骨折，观察治疗效果及其不良事件。 结果与结论：9例患者跟踪随防1.1~4.5年，平均随访2.5年，6例患者治疗后获得骨折愈合，平均愈合时间为6个月。2例长柄翻修结合钢丝环扎内固定的B2型患者和1例钢板固定C型患者骨折未愈合。提示根据骨折部位、假体稳定性和骨组织质量选择恰当的治疗方式，以及尽量保护骨折端血运是治疗股骨假体周围骨折的关键。

Periprosthetic femoral fractures in 9 cases following hip arthroplasty

BACKGROUND: The treatment for the periprosthetic femoral fracture following hip arthroplasty is difficult because of the metal prosthesis and the quality of local bone loss, and the appropriate treatment remains controversial. OBJECTIVE: To discuss an accurate preoperative planning and clinical effects according to the periprosthetic femoral fracture following hip arthroplasty. METHODS: A total of 9 patients with periporsthetic femoral fractures were treated in First Department of Orthopedics, First Affiliated Hospital of Xinjiang Shihezi University Medical School from February 2001 to June 2009 and were retrospectively reviewed. The patients were classified by Vancouver classification, including 1 case of A-type fracture, 3 of B1-type fracture, 4 of B2-type fracture and 1 of C-type fracture. The option of treatments included the conservative treatment, open reduction with internal fixation of wire or plate, long stem revision with wire, and the clinical effects and complications of those treatments were observed. RESULTS AND CONCLUSION: All the patients were followed for 1.1-4.5 years with a mean follow-up of 2.5 years; 6 patients received postoperative fracture healing and the average healing time was 6 months. Two B2-type fracture cases of long stem revision with wire and one C-type fracture case with internal fixation of plate were not healed. The key of the treatments applied for periprosthetic fractures is to select the appropriate therapy according to the site of fracture, stability of implant and quality of bone and prevention of the blood circulation of fracture.