【摘要】 目的　探讨髋关节置换术后外伤致假体周围骨折的治疗方法。　方法　回顾19 98年 6月～ 2 0 0 3年 6月收治的髋关节置换术后外伤致假体周围骨折患者 5例 ,男 2例 ,女 3例 ;年龄 52～ 71岁 ,平均 59岁。其中自行跌伤 4例 ,交通伤 1例。原实施髋关节置换术的原发病 :3例为股骨头无菌性坏死 ,2例为陈旧性股骨颈骨折不愈合。施行全髋关节置换 4例 (5髋 ) ,股骨头置换 1例。外伤致髋关节骨折距原髋关节置换时间为 1个月～ 17年。按Vancouver假体周围骨折分型标准 ,B型 3例 ,C型 2例。 2例 (B型 1例 ,C型 1例 )采用牵引行保守治疗 ,2例 (B型 )应用加长柄关节翻修术及形状记忆合金锯齿臂环抱内固定器或钢缆捆扎治疗 ,1例 (C型 )应用解剖钢板内固定。　结果　 5例患者均得到随访 ,随访时间 2个月～ 5年 ,骨折均愈合。无感染、骨折不愈合、内固定断裂等并发症发生。　结论　髋关节置换术后 ,外伤致假体周围骨折的治疗比较困难 ,由于骨折部位、原置换假体有无松动、患者骨质量、身体状况的不同 ,选择的治疗方案也不同。Van couver假体周围骨折分型标准及治疗方案是较好的指导原则。更多还原

【Abstract】 Objective To explore the management alternatives to tr aumatic periprosthetic femoral fractures after hip replacement. Metho ds A retrospective analysis was done on five cases of traumatic perip rosthetic femoral fractures posterior to hip replacement admitted in from June 1 998 to June 2003. There were two males and three females, with age range of 52- 71 years (average 59 years). One case suffered from traffic accident and the oth er four from slipping. Three cases had received hip replacement for femoral head aseptic necrosis, the other two for femoral neck non-union. Total hip replacem ent was carried out in four cases (five hips) and femoral head replacement in on e. These traumatic periprosthetic fractures occurred from one month to 17 years after hip replacement. According to classification to periprosthetic fracture of Vancouver (1995), there were 3 cases of type B and 2 type C. Two cases (one cas e of type B and one type C) were treated with traction and conservative treatmen ts, two (type B) with long shaft prosthesis revision combined with shape memory saw tooth embracing fixator or wires and one (type C) with anatomical plate inte rnal fixation. Results All 5 cases were followed up for f rom two months to five years and attained fracture union with no complications s uch as infection, nonunion or fixation breakage. Conclusions Traumatic periprosthetic femoral fractures after hip replacement are hard to deal with. The management alternatives differ according to fracture site, prost hesis loosening, bone quality and general status of patients. Classification cri teria and corresponding managements of periprosthetic fractures of Vancouver are proved to be suitable guidelines.更多还原