Brand Stephan, Ettinger Max, Omar Mohamed, Hawi Nael, Krettek Christian, Petri Maximilian
Trauma Department, Hannover Medical School, Germany.
Orthopaedic Department, Hannover Medical School, Germany.
Open Orthop J. 2015 Aug 31;9:405-11. doi: 10.2174/1874325001509010405. eCollection 2015.
Periprosthetic proximal femoral fractures are a major challenge for the orthopaedic surgeon, with a continuously increasing incidence due to aging populations and concordantly increasing numbers of total hip replacements. Surgical decision-making mainly depends on the stability of the arthroplasty, and the quality of bone stock. As patients final outcomes mainly depend on early mobilization, a high primary stability of the construct is of particular relevance. Osteosynthetic procedures are usually applied for fractures with a stable arthroplasty, while fractures with a loosened endoprosthesis commonly require revision arthroplasty. Osteoporotic bone with insufficient anchoring substance for screws poses one major concern for cases with well-fixed arthroplasties. Complication rates and perioperative mortality have remained unacceptably high, emphasizing the need for new innovations in the treatment of periprosthetic fractures. Transprosthetic drilling of screws through the hip stem as the most solid and reliable part in the patient might represent a promising future approach, with auspicious results in recent biomechanical studies.
人工关节周围股骨近端骨折是骨科医生面临的一项重大挑战，由于人口老龄化以及随之而来的全髋关节置换数量不断增加，其发病率持续上升。手术决策主要取决于关节成形术的稳定性和骨量质量。由于患者的最终结局主要取决于早期活动，因此构建物的高初始稳定性尤为重要。对于关节成形术稳定的骨折，通常采用骨合成手术，而假体松动的骨折通常需要进行翻修关节成形术。对于假体固定良好的病例，骨质疏松且缺乏足够的螺钉锚固物质是一个主要问题。并发症发生率和围手术期死亡率一直高得令人无法接受，这凸显了在人工关节周围骨折治疗方面进行新创新的必要性。通过股骨干假体钻孔作为患者体内最坚固可靠的部分，可能是一种有前途的未来方法，最近的生物力学研究取得了良好的结果。
