Bogoch E, Hastings D, Gross A, Gschwend N
Division of Orthopaedic Surgery, The Wellesley Hospital, University of Toronto, Ontario, Canada.
Clin Orthop Relat Res. 1988 Apr(229):213-20.
Twelve cases of supracondylar fracture of the femur in rheumatoid arthritis patients with previously implanted resurfacing or MacIntosh arthroplasty of the knee had long standing severe polyarticular rheumatoid arthritis (duration, ten to 41 years; mean 24.8 years). The fractures occurred following a long interval after implantation of the prosthesis (five to 204 months; mean, 92.3 months). Two fractures were treated by stable and two by unstable fixation; eight were treated nonoperatively. The fractures healed in a normal time with one exception, but the femur was shortened in ten cases (mean, 2.8 cm), and axially malaligned in nine. The ability to walk long distances decreased in eight cases and pain increased in seven; two prostheses were loosened and displaced. Because of the poor results of nonoperative management, internal fixation of these fractures is recommended in selected cases.
12例类风湿性关节炎患者发生股骨髁上骨折，这些患者之前接受过膝关节表面置换或MacIntosh人工关节置换术，患有长期严重的多关节类风湿性关节炎（病程10至41年，平均24.8年）。骨折发生在假体植入后的较长时间间隔之后（5至204个月，平均92.3个月）。2例骨折采用稳定固定治疗，2例采用不稳定固定治疗；8例采用非手术治疗。除1例例外，骨折均在正常时间愈合，但10例股骨缩短（平均2.8厘米），9例出现轴向畸形。8例患者长途行走能力下降，7例疼痛加剧；2例假体松动移位。由于非手术治疗效果不佳，建议在特定病例中对这些骨折进行内固定。
