【摘要】 背景:随着老龄化年龄加剧,假体置换患者的比例在逐渐上升,假体周围骨折的发生较为少见,文献报道发病率在0.1%-5%,但近年其发病率呈现逐渐上升趋势。假体周围骨折因骨折部位特殊,修复后可能出现较高并发症发生率和再手术率等,其治疗历来是骨科的难题。目的:探讨全膝关节置换后假体周围骨折的修复方法及其效果。方法:新疆维吾尔自治区人民医院自2007年1月至2012年12月共收治9例全膝关节置换后骨折患者,其中股骨骨折6例,胫骨骨折3例。修复术前请相关科室会诊处理,明确使用假体类型:PFC Sigma Depuy假体3例,BIOMET公司的Vanguard假体6例。根据影像学表现来分型,股骨假体周围骨折采用Kim分型,胫骨假体周围骨折采用Felix分类法。其中3例采用股骨远端锁定钢板内固定,3例给予髓内钉治疗,3例采用LISS系统内固定。在治疗后进行随访,以纽约特种外科医院膝关节评分评估膝关节功能,并记录并发症发生情况。结果与结论:9例患者修复术前检查均提示有骨质疏松症,修复后切口均一期愈合。所有患者获得随访,随访时间9-34个月。所有患者骨折均愈合(平均9.4周)。随访期内无双下肢深静脉血栓形成,无感染及假体松动的发生。修复后采用纽约特种外科医院膝关节评分评估膝关节功能:优良5例,较好3例,尚可1例。修复术后患者早期功能锻炼,并发症较少。提示多数膝关节假体周围骨折可以固定后一期愈合并且能够获得无痛的膝关节,在临床应根据假体类型及骨折类型选择合适的固定方式。更多还原

【Abstract】 BACKGROUND: As the number of elder patients become more and more, the number of arthroplasty operations becomes more, but periprosthetic fractures appear nearly 0.1%-5% as the report. The incidence of fractures grows up year by year. According to the part of fracture happened, it may have high incidence of complications and revision operation, and its treatment is also a big problem in orthopedics. OBJECTIVE: To explore the repair method and effect of periprosthetic fractures after total knee arthroplasty. METHODS: Nine patients had periprosthetic fractures around the knee joint and visited the Xinjiang Uygur Autonomous Region People’s Hospital from January 2007 to December 2012. There were six cases with femur fractures and three with tibia fractures. All the patients had consultations before operation to make sure the type of the prosthesis we used: PFC Sigma Depuy in three cases, and BIOMET Company’s Vanguard in six cases. From the X-ray, we used Kim Classify for femur fracture and used Felix Classify for tibia fracture. Three cases used locking compression plate. Three cases used intramedullary nail. Three cases used LISS system for internal fixation. Follow-up was conducted after treatment. New York Hospital for Special Surgery knee score was used to assess knee function. The occurrence of complications was recorded. RESULTS AND CONCLUSION: All nine patients had osteoporosis, and their wound was healed in one stage. Patients were followed up for 9-34 months. Fractures were healed in all patients in averagely 9.4 weeks. There was no deep vein thrombosis in limbs. No infection or loosening appeared. After repair, New York Hospital for Special Surgery knee score was utilized to assess knee function: excellent in five cases, good in three cases, and average in one case. After repair, early exercise was done in patients, and complications were less. These results indicate that periprosthetic fractures can be healed in one stage, and painless knee joint can be obtained. Suitable fixation manner can be obtained in the clinic according to the type of prosthesis and type of fractures.更多还原