全髋置换术后股骨假体周围骨折的治疗

目的分析全髋置换术后假体周围骨折的治疗方法及结果。方法回顾分析2003年1月至2007年12月收治的外伤所致的全髋置换术后假体周围骨折患者12例,男7例,女5例;年龄48～82岁,平均69.7岁。骨折发生于术后1个月～8年,平均3.3年。骨折发生原因：跌伤9例,交通伤2例,不明原因骨折1例。行关节置换术的原发病：股骨头缺血性坏死6例,髋关节退行性骨关节病4例,股骨颈骨折2例。根据Vancouver假体周围骨折分型标准：A型3例,B型7例,C型2例。A型采用保守治疗（外展卧床、牵引）及钢丝捆扎治疗,B型采用锯齿臂环抱内固定器、长柄假体翻修及异体皮质骨植骨治疗,C型应用解剖钢板内固定。结果12例患者均获得随访,随访时间1.5～5.5年,平均2年。除1例患者骨折未愈合外,余患者骨折均愈合,且均未发生感染、内固定断裂等并发症。结论全髋关节置换术后假体周围骨折的治疗棘手,治疗方案需结合骨折部位、原置换假体有无松动、局部骨质量、身体状况而制定。

Management of traumatic periprosthetic femoral fractures following total hip replacement

Objective To explore the management alternatives to traumatic periprosthetic femoral fractures after total hip replacement.Methods A retrospective analysis was done on 12 cases of traumatic periprosthetic femoral fractures after total hip replacement admitted in from January 2003 to December 2007.Seven males and five females were included, with age ranged from 48 to 82 years（average 69.7 years）.Two cases suffered from traffic accident,nine from slipping, and one from unknown reason.Among the reasons for total hip replacement,6 for avascular necrosis of femoral head,4 for osteoarthritis of hip joint,2 for femoral neck fracture.These periprosthetic fractures occurred from one month to 8 years after total hip replacement.According to the Vancouver classification for periprosthetic fracture,3 casesis classified to type A,2 type B,and 2 type C.Two cases（2 type A） received conservative treatments,8 cases（1 type A,7 type B） were treated with wires banding or shape memory saw tooth embracing fixator or long shaft prosthesis revision combined with integumentale hone grafting.Two（type C） were treated with anatomical plate internal fixation.Results All 12 cases were followed up for 1.5 to 5.5 years,except for 1 case（type A）,all attained fracture union,with no complications such as infection,nonunion or fixation breakage.Conclusion Traumatic periprosthetic femoral fractures after total hip replacement are difficult to handle.Management of peirprosthetic femoral fracture depends on fracture site,prosthesis loosening,bone quality and general condition of patients.