Culp R W, Schmidt R G, Hanks G, Mak A, Esterhai J L, Heppenstall R B
Clin Orthop Relat Res. 1987 Sep(222):212-22.
Sixty-one supracondylar fractures above prosthetic knee replacements in 58 patients were reviewed with a mean follow-up time of 3.7 years (range, 9 months to ten years). The mean interim between arthroplasty and fracture was 2.9 years (range, intraoperative to ten years). Twenty-seven cases demonstrated notching of the anterior femoral cortex. Seventeen patients suffered from a severe neurologic disorder. Group A consisted of 30 patients with 31 fractures treated by open reduction and internal fixation or revision arthroplasty. Follow-up study revealed 25 unions, three malunions, one nonunion, and two above-knee amputations for deep sepsis. Four of 31 patients had increased pain levels or change in ambulatory status postoperatively. Group B consisted of 30 fractures in 28 patients treated by casting alone or traction followed by cast bracing. Follow-up examination showed 17 unions, seven malunions, and six nonunions. Fifteen of the 30 patients had increased pain levels or change in ambulatory status after treatment. Casting produced significant decreases in motion in both groups. The results indicate that this fracture is associated with anterior notching of the femoral cortex and preexisting neurologic disorders. Patients with a supracondylar fracture following prosthetic knee arthroplasty are best managed by secure internal fixation and early motion.
对58例患者的61例人工膝关节置换术后髁上骨折进行了回顾性研究，平均随访时间为3.7年（范围为9个月至10年）。关节成形术与骨折之间的平均间隔时间为2.9年（范围为术中至10年）。27例患者出现股骨前皮质切迹。17例患者患有严重的神经系统疾病。A组由30例患者的31处骨折组成，采用切开复位内固定或翻修关节成形术治疗。随访研究显示25处骨折愈合，3处畸形愈合，1处不愈合，2例因深部感染行膝上截肢。31例患者中有4例术后疼痛程度增加或活动状态改变。B组由28例患者的30处骨折组成，仅采用石膏固定或牵引后石膏支具治疗。随访检查显示17处骨折愈合，7处畸形愈合，6处不愈合。30例患者中有15例治疗后疼痛程度增加或活动状态改变。两组患者石膏固定后活动度均显著降低。结果表明，这种骨折与股骨皮质前切迹和既往存在的神经系统疾病有关。人工膝关节置换术后髁上骨折患者最好采用可靠的内固定和早期活动进行治疗。
