髋关节置换术后股骨假体周围骨折的处理

Treatment of periprosthetic femoral fracture after total hip arthroplasty

目的:探讨分析全髋关节置换术后股骨假体周围骨折的分型、治疗方法及临床疗效。方法:回顾分析性研究2007-03～2010-08治疗8例全髋关节置换术后股骨假体周围骨折的病例,根据Vancouver分型B1型3例、B3型3例、C型2例。B1型病例采用异体皮质骨板加钢丝环扎牢固固定骨折,B3型病例采用股骨加长柄行翻修术外加同种异体结构骨植骨钢缆环扎术,C型病例均采用柄部单皮质骨螺钉内固定远端骨折部双皮质螺钉钢板内固定并植骨术。结果:所有病例均获随访8～24个月,股骨假体固定可靠,骨折断端对位对线良好,骨折均达到骨性愈合,患肢无疼痛、无肌萎缩,功能恢复正常,Harris评分平均83分。结论:对于髋关节置换术后假体周围骨折治疗应根据其综合情况及骨折分型采用个体化的手术治疗方法,可取得较好的治疗效果。

Objective：To investigate the classification criteria corresponding management and efficacy of treatment of periprosthetic femoral fracture after total hip arthroplasty.Methods： A retrospective analysis was done on 8 cases of periprosthetic femoral fractures after total hip arthroplasty admitted in from March 2007 to August 2010.According to Vancouver classification of periprosthetic fracture,there were 3 cases of type B1,3 of type B3 and 2 of type C.For 3 type B1 cases,the fracture were fixed with long allograft cortical bone and titanium cable,3 type B3 cases were treated with long shaft prosthesis revision combined with allograft cortical bone and titanium cable fixation,and the other 2 type C cases were treated with locked plate fixation.Results： All cases were followed up for 8-24 months,the femoral prosthesis wese rigidly fixed with the fracture well reduction and bony union.Both pain and amyotrophy were not found in all affected limbs.The function of the patients was well,and the mean Harris score was 83.Conclusion： For the management of the periprosthetic femoral fractures after hip replacement,the individualized treatment according to the general condition of the patient and the type of the fracture are the key points for reaching a good clinical result.