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股骨扩髓器锁定机制骨折及取出扩髓器的手术技术

Fracture of the Femoral Broach Locking Mechanism and Surgical Technique to Retrieve the Broach.

作者信息

Hsiue Peter P, O'Donnell Jeffrey A, Cheng Ryan, Sappey-Marinier Elliot, Si Selmi Tarik Ait, Boettner Friedrich

机构信息

Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York City, NY, USA.

Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.

出版信息

Arthroplast Today. 2025 Mar 15;32:101642. doi: 10.1016/j.artd.2025.101642. eCollection 2025 Apr.

DOI:10.1016/j.artd.2025.101642
PMID:40166079
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11957607/
Abstract

The current case series reports on 4 cases of intraoperative fracture of the femoral broach locking mechanism during total hip arthroplasty and subsequent entrapment of the broach. Three of the cases were performed via the direct anterior approach and 1 was performed with the posterolateral approach. Two femoral broach locking mechanisms fractured with the use of a power broaching device and 2 occurred when using the calcar planar. The authors also discuss a minimally invasive technique to remove the broach. While intraoperative fracture of the femoral broach locking mechanism is not a common complication, surgeons should be aware of the potential causes of these complications as well as strategies and techniques to retrieve the broach should they encounter this issue.

摘要

本病例系列报告了4例全髋关节置换术中股骨拉刀锁定机构的术中骨折及随后拉刀的卡压情况。其中3例通过直接前路进行，1例采用后外侧入路。2例股骨拉刀锁定机构在使用动力拉刀装置时发生骨折，2例在使用股骨矩平面时发生骨折。作者还讨论了一种微创技术来取出拉刀。虽然股骨拉刀锁定机构的术中骨折并非常见并发症，但外科医生应了解这些并发症的潜在原因，以及在遇到此问题时取出拉刀的策略和技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/ab399c3d8a10/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/a24650139a75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/83a951b667ea/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/498ca14ae8c1/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/65c7f123befc/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/f19f62922fe2/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/350a3c71fc7d/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/ab399c3d8a10/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/a24650139a75/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/83a951b667ea/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/498ca14ae8c1/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/65c7f123befc/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/f19f62922fe2/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/350a3c71fc7d/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd0a/11957607/ab399c3d8a10/gr7.jpg

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本文引用的文献

1
Energy expenditure of femoral broaching in direct anterior total hip replacements-Comparison between manual and automated techniques.直接前路全髋关节置换术中股骨扩髓的能量消耗——手动与自动技术的比较
Int J Med Robot. 2023 Nov 20:e2592. doi: 10.1002/rcs.2592.
2
Does Powered Femoral Broaching Compromise Patient Safety in Total Hip Arthroplasty?动力股骨扩髓在全髋关节置换术中会危及患者安全吗？
Arthroplast Today. 2023 Sep 19;23:101198. doi: 10.1016/j.artd.2023.101198. eCollection 2023 Oct.
3
Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty.
全髋关节置换术中使用手动和动力冲击器时外科医生在股骨准备和植入方面的差异。
Arthroplast Today. 2022 Jan 20;14:14-21. doi: 10.1016/j.artd.2021.10.005. eCollection 2022 Apr.
4
A Unique Complication of Femoral Broach Fracture and Incarceration During Total Hip Arthroplasty.全髋关节置换术中股骨拉刀骨折并嵌顿的一种独特并发症。
Arthroplast Today. 2021 Aug 21;11:49-53. doi: 10.1016/j.artd.2021.07.011. eCollection 2021 Oct.
5
Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty.手术自动化减少了直接前路全髋关节置换术的手术时间，同时保持了准确性。
J Orthop. 2020 Apr 1;22:68-72. doi: 10.1016/j.jor.2020.03.057. eCollection 2020 Nov-Dec.
6
The influence of broach design on bone friction and osseodensification in total hip arthroplasty.柄设计对全髋关节置换术中骨摩擦和骨密度增加的影响。
Clin Biomech (Bristol). 2020 Mar;73:234-240. doi: 10.1016/j.clinbiomech.2019.12.012. Epub 2019 Dec 18.
7
Quantitative characterisation of impaction events during femoral broaching in total hip arthroplasty.全髋关节置换术中股骨扩孔时嵌顿事件的定量特征。
Med Eng Phys. 2020 Feb;76:13-19. doi: 10.1016/j.medengphy.2019.12.004. Epub 2019 Dec 27.
8
Effect of cavity preparation and bone mineral density on bone-interface densification and bone-implant contact during press-fit implantation of hip stems.髋关节柄压配植入过程中，预备腔和骨密度对骨界面致密化和骨-种植体接触的影响。
J Orthop Res. 2019 Jul;37(7):1580-1589. doi: 10.1002/jor.24288. Epub 2019 Mar 28.