人工髋关节置换术后股骨假体周围骨折的分型与治疗  

Classification and treatment of periprosthetic femoral fractures after hip arthroplasty

作　　者：李志昌[1] 李儒军[1] 柯岩[1] 林剑浩[1] 

机构地区：[1]北京大学人民医院关节病诊疗研究中心(北京大学关节病研究所),100044

出　　处：《中华骨科杂志》2017年第15期952-960,共9页Chinese Journal of Orthopaedics

摘　　要：随着人工髋关节置换换手术数量的增加及假体寿命的延长，发生股骨假体周围骨折的病例也在逐渐增多。股骨假体周围骨折的手术难度大，翻修术后功能恢复、假体存活时间等均不及初次人工关节置换术，患者满意率低。股骨假体周围骨折的风险因素主要为患者骨质条件与手术技术两大类，具体包括年龄、性别、骨质疏松、既往手术史、假体类型等。为减少股骨假体周围骨折，应尽早采取预防措施，如初次手术前严格评估患者情况、选择合适的假体及手术方案；术中避免损伤骨质、保证假体正确安放；术后定期随访，对假体松动争取做到早发现、早处理。股骨假体周围骨折的诊断依赖详细的病史、症状、体征及术后系列X线检查。目前应用最广泛的股骨假体周围骨折分型系统为Vancouver分型系统。在治疗方向，VancouverA型骨折在多采用保守治疗；VancouverB型骨折通常需要手术治疗，根据假体是否松动决定采用单纯骨折内固定还是结合股骨柄假体翻修；VancouverC型骨折则遵循一般骨折治疗原则，但要注意骨折端股骨柄假体对内固定器械的遮挡。通过分析人工髕关节置换术后股骨假体周围骨折的发病机制和风险因素，并对股骨假体周围骨折的诊断、分型及治疗原则进行探讨，期望能为股骨假体周围骨折的规范治疗提供参考。With the increasing number of hip arthroplasty anti the extension of implant survival, the risk of periprosthetic femoral fractures are gradually growing. The technical challenge of the surgical management of periproslhetie femoral fraetures leads to poor functional outcome, implant survival and patient satistaetion compared to primary hip arthroplasty. The risk factors of periprosthetie femoral fractures involve both of the hone quality of the patient and the surgical techniques of the primary surgery, including age and gender of the patient, osteoporosis, previous surgical history and the type of the components. In order to avoid the occurrence of periprusthetie fractures, precautions including the assessment of the patient status and hone quality as well as the selection of proper prosthesis and surgical procedures should he taken betore the primary surgery. During the primary surgery, more attention should be paid In prevent the damage of host bone and make sure the correct placement of the implants. The aseptie loosening shouhl be detected and treated as early as possible in the regular post-operative follow up. The diagnosis of periprosthetie temural fracture mainly hases on the detailed history, symptoms, signs and serial X-rays after operation. The most extensively used classificatinn system of the periprosthetic femoral fracture is the Vancouver classificatiun. For the treatment of different types of fractures, conservative therapy is recommended for most Vancouver type A fractures. The surgical management is the best choice for most Vancouver type B fractures. Whether the stem revision is necessary or not depends un the stability the component, The treatment of Vancouver type C fractures shouhl he in aeeordanee with the prineipies of regular femur fraetures. However, more attention shouhl be paid to choose proper device according to the existence of the femoral eomponent in the proximal part of the fracture. Through the analysis of the pathogenesis and risk factors of periprosthetie femoral fractures an

关 键 词：假体周围骨折 关节成形术 置换 髋 再手术 

分 类 号：R687.3[医药卫生—骨科学]