Siegmeth A, Menth-Chiari W A, Wozasek G E, Vécsei V
University of Vienna Medical School, Vienna General Hospital, Trauma Center, Austria.
J South Orthop Assoc. 1998 Winter;7(4):251-8.
The number of periprosthetic femur fractures has increased due to the increase in the number of patients having total hip arthroplasty. In this study, we define indications for operative treatment in patients with femur fractures after hip arthroplasty. Fifty-three patients with 56 periprosthetic fractures were available for retrospective review of charts, radiographs, and physical examination; 42 fractures were treated with open reduction and internal fixation, 8 had replacement of hip prosthesis, 4 were treated with a retrograde genucephalic nail, and 2 patients were treated conservatively. The choice of treatment depended on the stability of the prosthesis and on the type and location of the fracture. Fifty-two fractures healed primarily. Three patients sustained a refracture, one an additional fracture, and two a deep infection. We recommend treatment with plate fixation for fractures without signs of prosthetic loosening. In fractures with loose implants, revision arthroplasty is required. Distal femoral fractures should be stabilized with a plate or with genucephalic nailing.
由于全髋关节置换术患者数量的增加，人工关节周围股骨骨折的数量也有所上升。在本研究中，我们明确了髋关节置换术后股骨骨折患者的手术治疗指征。对53例患者的56处人工关节周围骨折进行了回顾性病历、X线片及体格检查；42处骨折采用切开复位内固定治疗，8处进行了髋关节假体置换，4处采用逆行股骨髁上钉治疗，2例患者接受保守治疗。治疗方式的选择取决于假体的稳定性以及骨折的类型和部位。52处骨折一期愈合。3例患者发生再骨折，1例出现额外骨折，2例发生深部感染。对于无假体松动迹象的骨折，我们建议采用钢板固定治疗。对于假体植入物松动的骨折，则需要进行翻修关节成形术。股骨远端骨折应采用钢板或股骨髁上钉固定。
