窦勇;周一新;褚亚明;柳剑;

• 1:北京积水潭医院矫形骨科

摘要(Abstract)：

[目的]探讨采用非骨水泥型股骨假体进行髋关节翻修时术中骨折的发生率、发生原因及相关危险因素。[方法]回顾性研究北京积水潭医院矫形骨科2011年1～12月采用非骨水泥型股骨假体进行翻修的72例患者临床资料,其中男33例,女39例;均为单侧病变。患者翻修时的平均年龄61.7岁(32～82岁),距初次关节置换的时间平均为7.2年(1个月～20年)。分析非骨水泥股骨假体进行髋关节翻修时术中骨折的发生率及发生原因,并将未发生骨折的病例作为对照组,分析术中骨折发生的相关危险因素。[结果]72例翻修患者中有17例(23.6%)发生术中骨折。其中大转子劈裂骨折3例(13.3%)、股骨干部皮质穿孔3例(13.3%)、股骨干部螺旋形骨折8例(47.1%)、股骨干骨折合并股骨远端骨折3例(13.3%)。术中骨折最多见于取骨水泥时(41.2%),其次为开髓及扩髓过程中(29.4%)。[结论]采用非骨水泥股骨假体进行翻修时术中骨折的发生率较高。术中骨折的危险因素包括:术前严重的股骨骨缺损、较低的髓腔-皮质指数、术前假体力线不良及未采用大转子延长截骨的骨水泥型假体翻修。对于骨水泥型假体进行翻修时,大粗隆延长截骨可以有效避免术中骨折的发生。

关键词(KeyWords)： 髋;非骨水泥;翻修;术中骨折

Abstract:

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基金项目(Foundation):

作者(Author): 窦勇;周一新;褚亚明;柳剑;

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参考文献(References)：

• [1]Chunliu Z,Ronald K,Loyo-Berrios N,et al.Incidence and short-term outcomes of primary and revision hip replacement in the U-nited States[J].J Bone Joint Surg Am,2007,89:526-533.
• [2]Davidson D,Pike J,Garbuz D,et al.Intraoperative periprostheticfractures during total hip arthroplasty.Evaluation and management[J].J Bone Joint Surg Am,2008;90:2000-2012.
• [3]Myung SP,Ju-Hong L,Jong HP,et al.A distal fluted,proximalmodular femoral prosthesis in revision hip arthroplasty[J].J Arthro-plasty,2010,25:932-938.
• [4]Rüdiger JW,Mats OB,Anders E,et al.Minimum 5-year follow-up of a cementless,modular,tapered stem in hip revision arthro-plasty[J].J Arthroplasty,2011,26:16-23.
• [5]Della Valle CJ,Paprosky WG.Classification and an algorithmic ap-proach to the reconstruction of femoral deficiency in revision totalhip arthroplasty[J].J Bone Joint Surg Am,2003,4:1-6.
• [6]Masri BA,Meek RM,Duncan CP.Periprosthetic fractures evalua-tion and treatment[J].Clin Orthop,2004,420:80-95.
• [7]Meek D,Donald SG.Intraoperative fracture of the femur in revisiontotal hip arthroplasty with a diaphyseal fitting stem[J].J Bone JointSurg Am,2004,86:480-485.
• [8]Terzi S,Toni A,Zanotli Russo MC,et al.Intraoperative fracture ofthe femur in prosthetic hip reimplantations[J].Chir Organi Mov,1997,82:221-230.
• [9]Restrepo C,Mashadi M,Parvizi J,et al.Modular femoral stemsfor re-vision total hip arthroplasty[J].Clin Orthop,2011,469:476-482.
• [10]Issack PS,Guerin J,Butler A,et al.Intraoperative complications ofrevision hip arthroplasty using a porous-coated,distally slotted,fluted femoral stem[J].Clin Orthop,2004,425:173-176.
• [11]Chappell JD,Lachiewicz PF.Fracture of the femur in revision hiparthroplasty with a fully porous-coated component[J].J Arthro-plasty,2005,20:234-238.
• [12]刘玉杰,卢世璧,刘保卫,等.人工髋关节置换术并发股骨骨折临床分析[J].中华外科杂志,1998,36:93-95.
• [13]Wu CC,Au MK,Wu SS,et al.Risk factors for postoperative femo-ral fracture in cementless hip arthroplasty[J].J Formos Med Assoc,1999,98:190-194.
• [14]Egan KJ,Di Cesare PE.Intraoperative complications of revision hiparthroplasty using a fully porous-coated straight cobalt-chromefemoral stem[J].J Arthroplasty,1995,10:45-51.
• [15]Park YS,Moon YW,Lim SJ.Revision total hip arthroplasty using afluted and tapered modular distal fixation stem with and without ex-tended trochanteric osteotomy[J].J Arthroplasty,2007,22:993-999.