Eingartner Christoph, Volkmann Rüdiger, Ochs Uwe, Egetemeyr Daniel, Weise Kuno
Abteilung für Unfall- und Wiederherstellungschirurgie, Caritas-Krankenhaus, Bad Mergentheim.
Oper Orthop Traumatol. 2006 Oct;18(4):341-63. doi: 10.1007/s00064-006-1182-2.
Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis.
Periprosthetic femoral shaft fracture in the region of the prosthetic stem combined with preexistent loosening and/or defect in the periprosthetic bone bed (Vancouver classification type B2 and B3).
General contraindications, local infection.
Lateral transmuscular approach to the femoral shaft. Longitudinal osteotomy of the proximal femur taking the geometry of the fracture into account. Opening of an anterior "bone shell". Removal of the loose prosthetic stem and cement. Debridement. Preparation of the femoral diaphysis and insertion of a distally anchored revision stem. Distal locking. Repositioning of the "bone shell", reduction of the fracture, and retention with cerclage wires.
Bed rest for approximately 1 week, mobilization with 20 kg partial weight bearing for 12 weeks, gradual increase in weight bearing with radiologic checks on progress, removal of the distal locking bolts after 12-24 months at the earliest.
21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow-up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29-95 points).
通过髓内稳定的骨愈合机制实现假体周围骨折愈合及骨缺损区域修复。通过将翻修柄锚固于完整股骨干中，重建股骨干骨折的正确长度、轴向对线及旋转。
假体柄区域的假体周围股骨干骨折，合并假体周围骨床先前存在的松动和/或骨缺损（温哥华分型B2和B3型）。
一般禁忌证、局部感染。
股骨干外侧经肌入路。考虑骨折几何形态，对股骨近端进行纵行截骨。打开前方“骨壳”。取出松动的假体柄及骨水泥。清创。准备股骨干并插入远端锚固的翻修柄。远端锁定。复位“骨壳”，复位骨折，并用环扎钢丝固定。
卧床休息约1周，12周内以20 kg部分负重进行活动，根据影像学检查结果逐渐增加负重，最早在12 - 24个月后取出远端锁定螺栓。
21例患者（13例女性，8例男性），年龄43至86岁（平均年龄：71.2岁），均为股骨假体周围骨折，8例合并假体柄额外松动（温哥华B2型），13例合并额外骨丢失（温哥华B3型）。术后并发症：2例因再次跌倒发生骨折（再次手术：1例置换，1例钢板固定），4例因假体柄下沉进行翻修（3例置换，将假体更换为近端股骨愈合的标准柄，1例置换为另一种带锁翻修柄）。所有骨折平均在5.6个月（3 - 11个月）后实现骨愈合。平均4.5年的随访检查：所有患者均能行走，平均Harris评分70.5分（29 - 95分）。
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