Zha Zhen-gang, Lin Hong-sheng, Ekkernkamp Axel
Department of Orthopaedics, First Affi1iated Hospital of Medical School of Jinan University, Guangzhou 510630,China.
Di Yi Jun Yi Da Xue Xue Bao. 2004 Jan;24(1):91-3.
To investigate the clinical value of the different managements of periprosthetic femoral fractures (PFF). A retrospective study of 16 cases with PFF fixed respectively with cable, plates and screws, encircling device and altered long stem prosthesis was undertaken.
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 cases 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%.
Different types of PFF should be treated with different methods. Cable with 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 replacement accompanied by cable fixation, and locked nailing or encircling devices for distant part of the graft, were recommended for fractures happened from inferior edge of lesser trochanter to superior margin of narrowed segment of femoral stem. Steel plate or encircling devices fixation with bone graft is suitable for fractures occurred on inferior part of narrowed segment of femoral stem marrow.
探讨人工关节周围股骨骨折（PFF）不同处理方法的临床价值。对16例PFF患者进行回顾性研究，这些患者分别采用钢丝、钢板螺钉、环抱器及加长柄假体置换等方法进行固定。
临床及功能随访4至14个月，平均6个月。所有骨折均愈合，功能恢复良好。根据功能评估，其中3例评分在90分以上；9例评分在80至89分之间；3例评分在70至79分之间；1例评分63分。这些治疗的成功率为75%。
不同类型的PFF应采用不同的治疗方法。对于股骨颈至小转子的裂缝骨折，采用不锈钢丝环扎；对于完全裂缝骨折，植入较小型号的假体后用钢丝固定；对于小转子下缘至股骨干狭窄段上缘的骨折，建议采用加长柄假体置换并钢丝固定，对于假体远端骨折采用锁定髓内钉或环抱器固定。对于股骨干髓腔狭窄段下部的骨折，采用钢板或环抱器固定并植骨。
