人工髋关节置换术并发股骨假体周围骨折的治疗

目的回顾性研究人工髋关节置换术中及术后发生的股骨假体周围骨折的分型、治疗方法及相应临床疗效。方法将我院2000年1月～2007年1月收治的人工髋置换术中、术后发生股骨假体周围骨折的13例患者。按Van．couver分型A1型4例采用钢丝环扎固定；B1型4例采用异体皮质骨板加钢丝环扎或钢板钢缆固定加异体皮质骨板、自体髂骨混合植骨；132型3例采用长柄假体翻修、异体皮质骨板加钢丝环扎或钢板钢缆固定加异体皮质骨板、自体髂骨混合植骨；B3型2例骨折采用长柄假体翻修加异体皮质骨板、自体髂骨混合植骨、钢丝固定术，同时做髓腔内松质骨粒植骨，提高假体柄固定的强度及股骨侧皮质骨骨量。结果术后随访6—14个月，股骨假体固定可靠。骨折断端对位对线良好，未发生断端骨质吸收、骨折延迟愈合及不愈合、局部感染等。骨折断端及结构植骨处均骨性愈合。患者术后卧床时间1—4个月，平均3．5个月，术后随访Harris评分较术前有明显升高，患肢无疼痛、肌萎缩，功能恢复正常。结论Vancouver分型综合包含了骨折的位置、骨折的稳定性、假体的松动情况、股骨近端的骨量。因此对临床治疗有很好的指导意义。人工髋关节置换术中，术后股骨假体周围骨折，根据其骨折分型采用相应的固定方法，可取得较好的治疗效果。对于B2和B3型骨折患者，应注意骨折周围、髓腔内外充分植骨。

Treatment of femur periprothetic fracture during of after hip arthroplasty

Objective To summarize the experience of treatment of femur periprothetic fracture during or after hip ar- throplasty. Methods From 2000. 1. to 2007.1 1.13 patients with femur periprothetic fracture during of after hip arthroplasty were studied. Vancouver classification were used in this group. The internal fination of A1 type were steel wires. B1 were steel wire or plate with cortical and cancellous bone graft. B2 were revision with steel wire or plate with cortical and cancellous bone graft. B3 were revision with steel wire or plate with cortical bone and iliac cancellons bone graft. Results All patients were followed up for 6 - 14 months. Bony heal was obtained. The Harris Score increased significantly. Condusion Vancouver classification were significance for treatment. It is important for plan carefully before operation, recognize the lose of bone mass sufficiently and select firm internal fination as well as operate carefully.