Jukkala-Partio K, Partio E K, Solovieva S, Paavilainen T, Hirvensalo E, Alho A
Orton Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland.
Ann Chir Gynaecol. 1998;87(3):229-35.
In periprosthetic fracture associated with hip arthroplasty, no consensus exists about the use of plate fixation or revision stem except for cases where the stem is loose in a young patient and a revision is made. The aim of the present retrospective study was to compare two commonly used alternatives for treatment of the fracture--revision arthroplasty and plate fixation.
Seventy-five fractures associated with total hip arthroplasty were treated with revision arthroplasty (N = 40) or compression plate fixation (N = 35). Twenty-one fractures were intraoperative and 54 were postoperative. In revision arthroplasty, cemented (N = 11) and porous-coated (N = 29) stems were sued. Autologous bone grafts were used in 15 revision arthroplasties and 20 plate fixations. The follow-up time was median 20 months (range 12-96 months).
Bone grafting at the time of fracture treatment had no significant effect on fracture healing in the present setting. One patient in both groups was operated secondarily because of fracture instability. Five nonunions in the former and 9 nonunions in the latter group were treated by repeated revision and bone graft. In two revision arthroplasties and nine cases with plate fixation, a secondary bone grafting operation was performed for delayed union. In all, 20 secondary operations were needed after prosthesis stem revision and 27 secondary operations after plate fixation (p = 0.014). The need for reoperations was similar in fractures at different levels of the femur. Fracture healing was finally obtained in 39 revision arthroplasties and 34 cases with plate fixation during the follow-up period.
Cases where the prosthesis stem is stable, where its removal would include great risks and, where the biomechanical conditions are optimal, are best treated with plate fixation. In cases where the stem is loose and where a choice is possible, stem revision is preferable to plate fixation.
在与髋关节置换相关的假体周围骨折中，除了年轻患者假体柄松动并进行翻修的情况外，对于使用钢板固定还是翻修柄尚无共识。本回顾性研究的目的是比较两种常用的骨折治疗方法——翻修关节成形术和钢板固定。
75例与全髋关节置换相关的骨折采用翻修关节成形术（n = 40）或加压钢板固定（n = 35）治疗。21例骨折为术中骨折，54例为术后骨折。在翻修关节成形术中，使用了骨水泥型（n = 11）和多孔涂层型（n = 29）柄。15例翻修关节成形术和20例钢板固定术中使用了自体骨移植。随访时间中位数为20个月（范围12 - 96个月）。
在本研究中，骨折治疗时植骨对骨折愈合无显著影响。两组各有1例患者因骨折不稳定而再次手术。前一组有5例骨不连，后一组有9例骨不连，通过再次翻修和植骨进行治疗。在2例翻修关节成形术和9例钢板固定病例中，因骨愈合延迟进行了二次植骨手术。总体而言，假体柄翻修后需要20次二次手术，钢板固定后需要27次二次手术（p = 0.014）。股骨不同部位骨折的再次手术需求相似。随访期间，39例翻修关节成形术和34例钢板固定病例最终实现了骨折愈合。
假体柄稳定、去除假体柄风险大且生物力学条件最佳的病例，最好采用钢板固定治疗。在假体柄松动且有选择可能的情况下，翻修柄优于钢板固定。
