髋关节置换术中股骨假体周围骨折54例治疗与随访观察

Treatment and follow-up of intraoperative periprosthetic femur fractures:a report of 54 cases

目的研究股骨假体周围骨折的治疗方法及功能恢复情况。方法对2002年7月-2006年12月54例髋关节置换术中出现的股骨假体周围骨折进行回顾性分析,骨折分型使用Mallory分型系统,采用X线平片评价骨折愈合情况。结果对于稳定的Ⅰ型骨折和Ⅱ型骨折行钢丝环扎术,对近端骨折片完整的稳定Ⅱ型骨折采用保守治疗,假体不稳定的Ⅱ型骨折予以更换长柄非骨水泥假体,Ⅲ型骨折更换加长柄或采用LCP钢板进行固定。所有合并骨质疏松的骨折辅助异体骨板支撑植骨。术后随访5-52个月,平均23.5个月,除1例MalloryⅠ型骨折外其余全部愈合。随访期内假体无松动或下沉。Harris评分平均94.5分。结论髋关节置换术中股骨假体周围骨折多能顺利恢复功能。钢丝环扎、长柄假体、异体皮质骨板支撑植骨是治疗不同类型股骨假体周围骨折的有效方法,对近端骨折片完整的稳定的Ⅱ型骨折采用保守治疗也能达到良好的效果。

Objective To discuss the treatment of intraoperative periprosthetic fractures on the femoral side, and to evaluate the results of functional recovery after treatment. Methods Fifty-four cases of intraoperative periprosthetic fractures on the femoral side encountered from July 2002 to December 2006 were retrospectively studied. Fractures on the femoral side were classified by Mallory classification system. X-ray films were taken to evaluate the healing patterns of the fractures. Results Cerclage wires were adequate for stable type Ⅰ and type Ⅱ fractures, while it could be treated expectantly when the fracture did not involve proximal femur in stable type Ⅱ. Unstable type Ⅱ fractures were taken care of with a long-stem uncementoid component. Type Ⅲ fractures were taken care of with a long-stem uncementold component or LCP plate. Additional cortical strut allograhs were used for the management of unstable fractures and the fractures with poor host bone stock. The average follow-up time was 23. 5 months （5-52 months）. All fractures were healed as shown by radiography except one case of type Ⅰ fracture. There was no evidence of loosening or periprosthetic osteolysis on follow up radiograph. The mean postoperative Harris Hip Score was 94. 5. Conclusion The treatment of intraoperative periprosthetic fracture around the femoral implant can successfully restore the function of the hip joint in most patients. Cerclage wires, long-stem uncementoid component and additional cortical strut allograh were effective treatment methods for different types of intraoperative periprosthetic fractures on the femoral side. Expectant treatment can achieve satisfactory result in stable type Ⅱ fractures when the fracture did not destroy proximal femur.