人工髋关节置换术并发股骨骨折临床分析

The reason and management of intraoperative femur fracture during hip arthroplasty

目的探讨人工髋关节置换术并发股骨骨折的病因、治疗及预防。方法总结本院１９７２年４月～１９９６年６月行人工髋关节置换术９４５例，其中人工髋关节翻修术１４２例，初次人工髋关节置换术４９３例，人工股骨头置换３１０例。结果术中共发生股骨骨折２５例，总发生率为２．６％，其中人工髋关节翻修术８例，初次人工髋关节置换术１２例，人工股骨头置换５例。结论骨质疏松、医源性、先天性的股骨解剖结构改变以及软组织松解不彻底是发生术中骨折的主要原因。以下措施可有效地预防术中骨折的发生：（１）术前测量髓腔的大小，选择合适的假体；（２）彻底松解髋周软组织，脱位或复位时避免暴力；（３）用长假体应充分扩大髓腔；（４）假体置入时如遇有阻力，应避免强力打入，如突然有突破感，应考虑可能有骨折，应术中透视或照像。

Objective To study the pathogenesis,treatment and prevention of intrabperative femar fracture.Methods Intraoperative femur fracture occurred in 25(2 6%) of 945 hip arthroplasties performed from 1972 to 1996.142(5 6%) occurred in revision arthroplasties,12 (2 4%) 493 primary arthroplasties (2 4%),and 5(1 3%) in 310 semi arthroplasties.Results The causes of these fractures included osteoporosis. iatrogenic,congenital alteration of bony anatomy,and inadequate soft tissue release prior to hip dislocation during revision of hip surgery.Femoral fractures can be prevented by preoperative templating of rontgenograms containing markers to measure magnification;routine overdrawing of the femoral canal when implanting long stemmed prostheses;and a more extensive release of the external rotators and other scar tissue performed prior to dislocation.Any structures preventing free rotation of the femur should also be considered for the release.Conclusions We recommend that intraoperative roentgenograms be made whenever preparation of the femoral canal or impacting of the prosthesis is more difficult or when resistance is suddenly lost during implication of implant.When diagnosed intraoperatively,it sbould be fixed with cerclage wiring.When an incomplete fracture near the hip of the stem was discovered postoperatively and the posterior part of the femoral cortex was intact, a spica cast was applied. For a complete fracture at the tip of stem,we recommend open reduction and internal fixation.