全髋关节置换术后股骨假体周围骨折的治疗策略

The treatment of periprosthetic femoral fractures after total hip arthroplasty

股骨假体周围骨折是全髋关节置换(total hip arthroplasty,THA)术后严重的并发症。由于接受THA患者数量逐年增加,假体周围骨折的发病率也随之上升。假体周围骨折的危险因素包括年龄、性别、跌倒、假体周围骨溶解、假体松动等。Vancouver分型是股骨假体周围骨折最常用的分型方法,根据骨折部位及假体是否稳定、是否存在骨缺损将假体周围骨折分为:A型,股骨转子间骨折;B型,假体柄周围骨折(B1为柄稳定,B2为柄松动、无骨缺损,B3为柄松动伴骨缺损);C型,假体柄以远骨折。部分类型股骨假体周围骨折在股骨柄假体是否稳定固定、假体是否需要翻修、股骨柄假体的选择、骨缺损重建与骨折固定方式和固定手段等方面存在一定的争议。本文复习并系统回顾THA术后股骨假体周围骨折的相关文献,并结合华西医院THA术后股骨假体周围骨折的诊治经验,就THA术后股骨假体周围骨折的发生率、危险因素、分型方法、治疗原则与策略进行综述,比较各类治疗方法的优缺点,指导股骨假体周围骨折的治疗。

Periprosthetic femoral fracture (PFF) is one of severe complications after total hip arthroplasty (THA). As the number of patients receiving THA increased recently, the incidence of PFFs also increased dramatically. There are a number of risk factors for PFFs, such as age, sex, falling and prosthesis loosening. The Vancouver classification system is the most commonly used classification method for PFFs. According to the fracture location, PFFs can be divided into type A intertrochanteric fracture, type B fracture around the stem and type C fracture beyond the stem. The Vancouver type B PFF is further subdivided into type B1 with a well-fixed prosthesis, type B2 with a loose prosthesis but with adequate bone stock, and type B3 with a loose prosthesis and poor proximal bone stock simultaneously. Currently, there are some controversies in treating PFFs, mainly including whether the stem is fixed or not, whether the prosthesis needs to be revised, the selection of the stem, the reconstruction of bone defects, and the methods of fracture fixation. We searched literatures related to PFFs after THA. The incidence, risk factors, classification methods, treatment principles and strategies of PFFs were summarized in the present study. Based on our long-term clinical experience, we evaluated the advantages and disadvantages of each treatment method and provided considerations for the clinical research and selection in treating PFFs.