Felix N A, Stuart M J, Hanssen A D
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 1997 Dec(345):113-24.
One hundred two periprosthetic tibial fractures associated with total knee arthroplasty were identified in 29 men and 73 women. Eighty-three fractures occurred postoperatively, and 19 occurred intraoperatively. Fractures were classified into four types based on location and proximity to the prosthesis. There were 61 Type I fractures, occurring at the tibial plateau; 22 Type II fractures, occurring adjacent to the prosthetic stem; 17 Type III fractures, occurring distal to the prosthetic stem; and two Type IV fractures, involving the tibial tubercle. Fracture types were additionally classified by whether the prosthesis appeared to be radiographically well fixed (A) or loose (B) at the time of fracture, or whether the fracture occurred intraoperatively (C). The majority of postoperative Types I and II fractures were Types IB and IIB, and these were treated most successfully with revision surgery. Types IIA, IIIA, and IVA fractures were managed successfully by the usual principles of tibial fracture treatment. Type IC fractures usually were managed by intraoperative fixation, Type IIC by bone grafting or external immobilization and weightbearing restrictions, and Type IIIC by conventional fracture management. This classification system provides a guide for determining the appropriate treatment for tibial fractures associated with total knee arthroplasty.
在29名男性和73名女性中，共识别出102例与全膝关节置换术相关的假体周围胫骨骨折。83例骨折发生在术后，19例发生在术中。根据骨折部位及与假体的距离，骨折分为四种类型。I型骨折61例，发生在胫骨平台；II型骨折22例，发生在假体柄附近；III型骨折17例，发生在假体柄远端；IV型骨折2例，累及胫骨结节。骨折类型还根据骨折时假体在X线片上显示固定良好（A）、松动（B）或骨折发生在术中（C）进行进一步分类。大多数术后I型和II型骨折为IB型和IIB型，采用翻修手术治疗最为成功。IIA型、IIIA型和IVA骨折按胫骨骨折的常规治疗原则成功处理。IC型骨折通常通过术中固定处理，IIC型通过植骨或外固定及限制负重处理，IIIC型通过传统骨折处理方法处理。该分类系统为确定全膝关节置换术相关胫骨骨折的合适治疗方法提供了指导。
