人工髋关节置换术并发股骨骨折临床分析

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1、人工髅关节置换术并发股骨骨折临床分析中华外科杂志1998年第2期第36卷临床论著作者：刘玉杰卢世璧刘保卫林峰•单位:100853北京，中国人民解放军总医院骨科关键词：人工关节；槻假体；股骨骨折【摘要】目的探讨人工谶关节置换术并发股骨骨折的病因、治疗及预防。方法总结木院1972年4月〜1996年6月行人工競关节置换术945例，其中人工瓠关节翻修术142例，初次人工骯关节置换术493例，人工股件头置换310例。结果术中共发生股骨骨折25例，总发生率为2.6%,其中人工髏关节翻修术8例，初次人丄髏关节置换术12例，人工股骨头置换5

2、例。结论骨质疏松、医源性、先天性的股骨解剖结构改变以及软组织松解不彻底是发生术中忖折的主要原因。以下措施可有效地预防术中忖折的发生：(1)术前测量髓腔的大小，选择合适的假体；(2)彻底松解髏周软组织，脱位或复位时避免眾力；(3)用长假体应充分扩人髓腔:(4)假体置入时如遇有阻力，应避免强力打入，如突然令突破感，应考虑可能有骨折，应术中透视或照像。ThereasonandmanagementofintraoperativefemurfractureduringhiparthroplastyLiuYujie,LuShibi,Li

3、uBaowei,etal.DepartmentofOrthopedics,GeneralHospitalofPeoplesLiberationArmy,Beijing100853.【Abstract】ObjectiveTostudythepathogenesis,treatmentandpreventionofintrabperativefemarfracture.MethodsIntraoperativefemurfractureoccurredin25(2.6%)of945hiparthroplastiesperform

4、edfrom1972to1996.142(5.6%)occuiTedinrevisionarthroplasties,12(2.4%)493prinKiryarthroplasties(2.4%),and5(1.3%)in310semi-arthroplasties.ResultsThecausesofthesefracturesincludedosteoporosis,iatrogenic,congenitalalterationofbonyanatomy,andinadequatesofttissuereleasepri

5、ortohipdislocationduringrevisionofhipsurgery.Femoralfracturescanbepreventedbypreoperativetemplatingofrontgenogramscontainingmarkerstomeasuremagnification;routineoverdrawingofthefemoralcanalwhenimplantinglong-stemmedprostheses;andamoreextensivereleaseoftheexternalro

6、tatorsandotherscartissueperformedpriortodislocation.Anystructurespreventingfreerotationofthefemurshouldalsobeconsideredfortherelease.ConclusionsWerecommendthatintraoperativeroentgenogramsbemadewheneverpreparationofthefemoralcanalorimpactingoftheprosthesisismorediff

7、icultorwhenresistanceissuddenlylostduringimplicationofimplant.Whendiagnosedintraoperativelyjtshouldbefixedwithcerclagewiring.Whenanincompletefracturenearthehipofthestemwasdiscoveredpostoperativelyandtheposteriorpartofthefemoralcortexwasintact,aspicacastwasapplied.F

8、oracompletefractureatthetipofstem,werecommendopenreductionandinternalfixation.[Keywords]JointprosthesisHipprosthesisFemoralfractures人工僦关节置换术中股骨骨折