术中防治人工髋关节置换术假体周围骨折的体会

Prevention and treatment of periprosthetic fractures during hip arthroplasty

目的分析全髋置换术术中假体周围骨折的防治方法及结果。方法回顾分析本院自2006年1月至2009年12月所有行髋关节置换手术患者238例,包括初次置换术195例,翻修术43例。术中发生假体周围骨折30例,按照Vancouver分型,A型骨折12例,B型骨折3例,C型骨折15例。根据其骨折类型给予捆绑带环扎治疗,记忆合金环抱器及异体皮质骨植骨治疗,解剖钢板内固定治疗。结果术中骨折30例患者,经术中及时处理,随访12个月至25个月,骨折均愈合,Harris评分(90±3)分。结论骨质疏松,术中操作不当,假体型号选择不匹配,周围软组织松解不彻底是术中骨折的主要原因,对骨质疏松患者,手术技巧,骨溶解等危险因素进行干预,根据Vancouver分型对术中骨折给予相应处理是防治髋关节置换术术中假体骨折的关键。

Objective To analyze the prevention and treatment of periprosthetic fractures during Hip arthroplasty.Methods To retrospectively analyze all hip replacement surgery patients from January 2006 to December 2009,including 195 cases of primary arthroplasty,revision surgery in 43 cases.Intraoperative periprosthetic fractures in 30 cases,In accordance with the Vancouver classification,A-type fracture in 12 cases,B-type fracture in 3 cases,C-type fracture in 15 cases.according to their type of fracture,the option of treatments included cerclage,memory alloy embracing fixator and bone graft treatment of allograft cortical bone,anatomical plate fixation.Results All 30 cases were followed up for 12~25 months and all fractures healed,Harris score（90±3） minutes.Conclusion Osteoporosis,improper operation surgery,prosthesis type chosen does not match and the surrounding soft tissue release surgery is not complete,are main reasons for fracture.The key of the treatments applied forperiprosthetic fractures is to select the appropriate therapy according to type of surgery in Vancouver and prevent Osteoporosis,surgical techniques and other risk factors.