股骨假体周骨折治疗方法的探讨

Exploration of the treatment for the periprosthetic femoral fractures

目的 探讨股骨假体周骨折不同处理方法的临床应用价值。方法 对16例股骨假体周骨折分别采用钢丝、钢板螺钉、环抱器固定和更换长柄假体植入方法处理．总结分析其相关临床资料。结果 16例病人术后随访4～14个月．平均6个月，全部病例骨折愈合，功能恢复良好。髋关节功能评定：90分以上3例、80～89分9例、70-79分3例、63分1例，优良率达75％。结论 股骨假体周骨折类型不同，处理方法应不同：股骨颈端到小粗隆下缘的劈裂骨折，采用钢丝捆扎；全劈裂骨折移位明显，更换较小型号的假体，再用钢丝捆扎固定并植骨；小粗隆下缘到股骨干髓腔狭窄段的上缘骨折，选用长柄假体植入再用钢丝捆扎，假体远端加锁固定或选用环抱器固定；股骨干髓腔狭窄段以下的骨折，采用钢板固定或环抱器固定并植骨。

Objective and Methods To in vestigate the clinical value of the different managements of periprosthetic femo ral fractures (PFF). A retrospective study of 16 cases with PFF fixed respectiv ely with cable, plates and screws, encircling device and altered long stem pros thesis was undertaken. Results Clinical and functional results were followed-up from 4 to 14 months with an average of 6 months. All the fractures were healed with excellent functional recoveries. Three of these cases scored above 90; 9 c ases scored 80 to 89; 3 cases scored 70 to 79; and 1 case scored 63 according to the functional evaluation. The success rate of these treatments was 75%. Concl usions Different types of PFF should be treated with different methods. Cable w ith stainless steel cerclage was used for fissure fracture from the femoral neck to lesser trochanter; a smaller type of prosthesis was grafted and then fixed with the cable for complete fissure fracture; longer prosthetic stem graft repla cement ac-companied by cable fixation, and locked nailing or encircling devices for distant part of the graft, were recommended for frac-tures happened from inf erior edge of lesser trochanter to superior margin of narrowed segment of femora l stem. Steel plate or encircling devices fixation with bone graft is suitable for fractures occurred on inferior part of narrowed segment of femoral stem mar row.