骨钩复位技术联合外侧髌旁入路治疗全膝关节置换术后假体周围股骨远端骨折：技术要点

Bone Hook Reduction Technique Combined with Lateral Parapatellar Arthrotomy for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty: A Technical Note.

机构信息

Department of Orthopaedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea.

出版信息

Orthop Surg. 2022 Aug;14(8):1902-1906. doi: 10.1111/os.13349. Epub 2022 Jun 22.

DOI:10.1111/os.13349

PMID:35733274

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9363775/

Abstract

OBJECTIVE

To report a bone hook reduction technique combined with lateral parapatellar arthrotomy for periprosthetic distal femoral fractures following total knee arthroplasty (TKA).

METHODS

From April 2012 to June 2018, a total of 31 knees who underwent this technique for the treatment of periprosthetic distal femoral fractures following TKA were retrospectively reviewed. Through a lateral parapatellar arthrotomy, the vastus lateralis fascia was dissected from the muscle belly to allow anteromedial mobilization of the muscles. With direct visualization of the posteriorly angulated distal fragment, a bone hook was placed on the anterior flange of the femoral component. The hook was then elevated to correct the posteriorly angulated and shortened distal fragment. The coronal and sagittal alignments of the distal segment with the femoral shaft were confirmed using fluoroscopic images, and internal fixation was performed using an anatomically pre-contoured lateral locked plate. Once the overall length and sagittal plane alignment were restored, the plate was inserted via the previous articular approach. The plate was centered on the femur using anteroposterior and lateral fluoroscopy and then fixed.

RESULTS

A total of 28 patients underwent internal fixation using the bone hook reduction technique combined with lateral parapatellar arthrotomy for the treatment of periprosthetic distal femoral fractures following TKA. The average age at operation was 70.9 years (range, 62-83 years), and the average follow-up period was 17.5 months (range, 12-48.5 months). Fractures were classified as Su type I (13/28 [46.4%]), type II (11/28 [39.3%]), and type III (4/28 [14.3%]). Bone union was confirmed radiographically in all patients.

CONCLUSION

The bone hook reduction technique is a simple and effective method to reduce the distal fragment in periprosthetic distal femoral fractures following TKA.

摘要

目的

报告一种骨钩复位技术，结合外侧髌旁入路治疗全膝关节置换（TKA）后假体周围股骨远端骨折。

方法

回顾性分析 2012 年 4 月至 2018 年 6 月采用该技术治疗 TKA 后假体周围股骨远端骨折的 31 例患者。通过外侧髌旁入路，将股外侧肌的阔筋膜从肌腹中分离出来，以允许肌肉前内侧移动。在直视下，将骨钩置于股骨假体的前凸缘上。然后抬起钩子以纠正向后成角和缩短的远端骨折块。通过透视图像确认远端节段的冠状面和矢状面与股骨干的对齐情况，并使用解剖预成型的外侧锁定钢板进行内固定。一旦恢复了整体长度和矢状面的对线，就通过之前的关节入路插入钢板。使用前后位和侧位透视确定钢板在股骨上的中心位置，然后固定。

结果

共有 28 例患者采用骨钩复位技术结合外侧髌旁入路治疗 TKA 后假体周围股骨远端骨折，进行了内固定。手术时的平均年龄为 70.9 岁（范围 62-83 岁），平均随访时间为 17.5 个月（范围 12-48.5 个月）。骨折分为 Su 型Ⅰ（13/28 [46.4%]）、Ⅱ型（11/28 [39.3%]）和Ⅲ型（4/28 [14.3%]）。所有患者均经影像学证实骨折愈合。