发育性髋关节发育不良全髋关节置换术中出现假体周围骨折9例

选择2002-02/2007-05在天津医院关节外科发育性髋臼发育不良、初次人工全髋关节置换术中出现假体周围骨折的患者9例（9髋）。男1例，女8例，年龄52~69岁。初次全髋关节置换选用股骨假体与髓腔锉同号，髋臼假体直径比髋臼锉直径大2 mm。对患者术后疼痛、功能、活动范围、畸形程度进行Harris评分。随访时间最短1年，最长6年。髋臼骨折中4例为稳定性骨折，给予多枚螺钉加强固定，1例为不稳定性骨折，给予结构性植骨配合多枚螺钉固定；股骨骨折中1例为Vancouver AG型，给予钢丝捆绑固定，3例为B1型，给予锁定加压钢板（LCP）内固定或钢丝捆绑，1例为C型，给予LCP内固定。定期复查X射线片，未发现髋臼假体周围透亮带及松动表现。Harris评分平均为87.2分。结果表明：在发育性髋臼发育不良患者初次人工全髋关节置换术术中，选用的非骨水泥型髋臼假体直径应当不超过髋臼锉直径2 mm。对于骨折疏松明显的患者，最好选用与髋臼锉相同直径的髋臼假体并使用螺钉固定，或选用骨水泥型假体。当出现髋臼骨折时，可选用多枚螺钉固定或同时进行髋臼植骨。术中发生骨折，应当根据骨折类型和假体稳定性选用适合的固定方式。

Periprosthetic fractures during primary total hip arthroplasty for developmental dysplasia of the hip in 9 cases

From February 2002 to May 2007, 9 cases (9 hips) of periprosthetic fractures during the primary total hip arthroplasty for developmental dysplasia of the hip were selected, including 1 male and 8 females aged 52-69 years. In the primary total hip arthroplasty, femoral prosthesis with the same size as intramedullary reamer and acetabular prosthesis with 2 mm diameter larger than acetabular reamer were used. The pain, function, range of motion and degree of deformity were accessed using the Harris score. The patients were followed for 1-6 years. Among the 9 patients with periprosthetic fractures, 4 acetabular fractures were stable which were treated by additional augmentation screws, and 1 fracture was unstable which was treated by structural bone grafting and additional screws. And there was one Vancouver type AG fracture which was treated by cerclage wire, 3 Vancouver B1 fractures which were fixed by locking compression plate (LCP) or cerclage wire, and one Vancouver type C fracture which was also fixed by LCP. No component loosening or migration was found in the postoperative X-ray. The mean Harris score was 87.2 at the final follow-up. The results of the study show that during the primary total hip arthroplasty in patients with developmental dysplasia of the hip, the oversize of the acetabular component should be controlled to equal to or less than 2 mm. For patients with severe osteoporosis, acetabular components with the same size to reamer are recommended combined with additional screws, or cemented cup. When an acetebular fracture is found during total hip arthroplasty, we could use additional screws or bone grafting. Once a periprosthetic femoral fracture occurs during the operation, methods of fixation should be selected based on the type of the fracture and stability of the prosthesis.