全膝关节置换后股骨假体周围的骨折(英文)  

Periprosthetic femoral fracture after total knee arthroplasty

作　　者：朱兴阳[1] 苏海涛[2] 黄永明[2] 

机构地区：[1]广州中医药大学第二临床医学院,广东省广州市510405 [2]广东省中医院骨科,广东省广州市510006

出　　处：《中国组织工程研究》2013年第39期6887-6895,共9页Chinese Journal of Tissue Engineering Research

摘　　要：背景:全膝关节置换后股骨假体周围骨折与骨质疏松、骨缺损、假体、患者脆弱以及高并发症发生率等因素有关,其防治较困难。目的:综合近几年的文献以探讨全膝关节置换后股骨假体周围骨折的危险因素、分型、治疗、康复及预防。方法:应用计算机分别检索PubMed和Spinger Link数据库相关文献,检索时间分别设定为1990年1月1日至2011年12月31日和1980年至2011年,检索词设定为"periprosthetic fracture,knee",检索语言设定为英语,共检索到626篇文章。结果与结论:按纳入和排除标准对文献进行筛选,共纳入40篇文章。结果表明,随着全膝置换在临床中的广泛开展,股骨假体周围骨折的发生率正在逐年增高,因其预后较差,所以要重视其预防,这一骨折的危险因素包括患者自身内在的难以控制的因素和固定技术等外在因素。Rorabeck分型是全膝置换后股骨假体周围骨折最常用的分型方法,但其在临床应用中并不理想;Kim分型将会更有效的指导临床。股骨假体周围骨折的治疗包括非手术治疗、切开复位内固定、逆行髓内钉以及翻修等,合适治疗方案的选择主要取决于骨折的类型、局部骨质量、患者的健康状况等,目前尚缺乏完美的原则来指导选择合适的治疗措施,置换后早期功能锻炼将有益于预防固定过久引起的相关并发症及关节功能的丢失。因此,全膝关节置换后股骨假体周围骨折的治疗要严格把握适应证,在牢固固定的同时,应该尽量鼓励患者早期功能锻炼。BACKGROUND：Periprosthetic femoral fracture after total knee arthroplasty is related with the osteoporosis, bone defects, prosthesis, frail patients and high complication rate, so it is difficult to prevent and treat. OBJECTIVE：To explore the risk factor, classification, treatment, rehabilitation and prophylaxis of periprosthetic femoral fracture after total knee arthroplasty based on the reviewed and summarized articles published in recent years. METHODS：A computer-based online search was conducted in PubMed database from January 1, 1990 to December 31, 2011 and in SpringerLink database from 1980 to 2011 for the related articles with the key words of“periprosthetic fracture, knee”in English. A total of 626 articles were retrieved. RESULTS AND CONCLUSION：According to inclusion and exclusion criteria, the articles were screened and 40 articles were included final y. The results showed that with the extensive development of total knee arthroplasty, the incidence of periprosthetic femoral fracture was increased gradual y;due to the poor prognosis, we should pay attention to the prevention. The risk factors of periprosthetic femoral fracture included patients’ internal factor that was hard to control, and some external factors such as the surgical techniques. Rorabeck classification was commonly applied for periprosthetic femoral fracture after total knee arthroplasty, but it was not perfect in clinical application. Kim classification wil be better for clinical guidance. The treatment of periprosthetic femoral fracture included nonoperative treatment, open reduction and internal fixation, retrograde intramedul ary nailing and revision arthroplasty. An appropriate treatment is chosen depending on fracture classification, local bone quality,patients’ medical and nutritional status. At present, however, there is not a perfect guideline for the selection of appropriate treatment method. But the early functional exercise is beneficial to prevent the related complications caused by longtime immobilizat

关 键 词：骨关节植入物 骨与关节综述 骨组织工程研究 人工假体 假体周围骨折 全膝关节置换 股骨 治疗 康复 预防 功能锻炼 

分 类 号：R318[医药卫生—生物医学工程]