髋关节置换髋臼假体周围骨折的研究进展

Advancements in periprosthetic acetabular fractures related to hip replacement

随着生物型假体在髋关节置换术中的广泛应用,高能量创伤的出现以及患者寿命的延长,原本罕见的并发症—髋臼假体周围骨折的发生率也在不断增加。这种骨折可使髋臼假体松动,造成严重的后果。对于髋臼假体周围骨折的危险因素、分类标准、治疗策略及预防措施,不同学者提出不同的见解。本文的危险因素讨论包括周边自锁髋臼杯的使用、女性、年龄以及原发病等其他因素。髋臼假体周围骨折的分类标准从1996年提出开始,直至今日,一直在不停发展,其中,改良Paprosky分类应用的最为广泛。此标准将髋臼假体周围骨折分为5种类型:术中继发于髋臼假体压配过程中的骨折、术中继发于髋臼假体移除过程中的骨折、外伤性骨折、自发性骨折以及骨盆中断。本文髋臼假体周围骨折的治疗也是按照Paprosky分类进行分别讨论。髋臼假体稳定性的评估对于决定治疗方案是保守治疗还是手术治疗,起着至关重要的作用。髋臼假体周围骨折治疗的总体原则是使髋臼柱足够的稳定,从而有效支撑髋臼假体,并且可以防止髋臼假体与骨质间的移位。本文就预防措施从术前、术中及术后3个方面进行了讨论。

Incidence of periprosthetic acetabular fractures is continuously increasing,rare complications before,with the wide application of biological prosthesis in hip replacement,the emergence of high-energy trauma and the prolongation of patient’s life span.These fractures can loosen the acetabular prosthesis and cause serious consequences.Different scholars have different opinions on the risk factors,classification criteria,treatment strategies and preventive measures of acetabular periprosthetic fractures.Risk factors discussed in this article include the use of peripheral self-locking acetabular cups,female sex,age,and primary diseases.The classification criteria of periprosthetic fractures of acetabulum have been developing since 1996.Among them,the modified Paprosky classification is the most widely used one.According to this criterion,periprosthetic fractures of acetabulum can be classified into five types:intraoperative fractures secondary to acetabular component insertion,intraoperative fracture secondary to acetabular component removal,traumatic fracture,spontaneous fractures and pelvic discontinuity.The treatment in this essay of periprosthetic acetabular fractures is also discussed according to Paprosky classification.Assessment of stability of acetabular prosthesis plays an important role in deciding whether to treat conservatively or surgically.The general principle of treatment of periprosthetic acetabular fractures is to make the acetabular columns stable enough to support the acetabular prosthesis effectively,and to prevent the displacement between the acetabular prosthesis and bone.Preventive measures were discussed in this review from three aspects:preoperation,intraoperation and postoperation.