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ID:55627793
大小:10.37 MB
页数:25页
时间:2020-05-21
《假体周围骨折的分型与治疗方案.ppt》由会员上传分享,免费在线阅读,更多相关内容在PPT专区-天天文库。
1、PeriprostheticFracturesClassificationandTreatmentIncreasingNumbersMoreArthroplastiesMoreInternalFixationOsteoporoticFracturesMoreIndependentElderlyMoreRevisionsIncidenceIncreasingBetween1987–2003Incidence0.14%Between2004–2007Incidence0.78%?????????EarlierMobilizationSmallerIn
2、cisionsProximallyCoatedStems?????????Berryet.al.2007“…itisbecomingalittlebitofaminiepidemic.”D.Berry,MDIntraoperativeFractureCementedHipStem<1%incidenceoffractureCementlessHipStem3%-20%incidenceoffractureRevisionarthroplasty6.3%withcementedstem17.6%withcementlessstemIntraopera
3、tiveFractureRiskFactorsCementlessImplantRevisionSurgeryDecreasedBoneStrengthOsteoporosisRaDeformitySurroundingImplantIntraoperativeFractureTreatmentFractureProximalToLesserTrochanterCablesCollaredImplantPerforationsLongerStem-bypassPerforationBy21/2CanalDiameters+/-Supplemen
4、talBoneGraftingPeriprostheticFracturesRiskFactorsDecreasedbonestrengthPerforationsLoosestemOsteolysisStressrisersScrewholesTreatmentGoalsUnitedFractureAnatomicAlignmentStableProsthesisEarlyMobilizationReturnToPreviousFunctionTreatmentManyOption/PermutationsNon-operativeRevisi
5、onArthroplastyAnd/OrORIFAnd/OrStrutGraftingNoClearConsensusEachCaseMustBeIndividualizedCriticalFactorsStabilityOfTheProsthesisLocationOfTheFractureRelativeToProsthesisQualityOfBonePatientAgeMedicalConditionBaselineStatusVancouverClassification(FracturesAboutTHAStems)Considera
6、tionsLocationOfTheFractureImplantStabilityBoneQualityVancouverClassificationTypedeterminedbylocationTypeATrochantericregionTypeBAbouttipofstemTypeCDistaltotipofstemTypeB(AtTip)SubClassificationTypeB1ImplantIsStableTypeB2ImplantIsLooseSatisfactoryBoneTypeB3ImplantIsLooseInadeq
7、uateBoneStockTreatmentTypeA-TrochantericRegionUsuallyStableProtectedWBORIFCablesPlatePlate+CablesVancouverTypeCTreatmentORIFAvoidStressRiserBetweenImplantsOverlapFixationDeviceWithImplantMaintain>2½CorticalDiametersBetweenDevicesTreatmentVancouverTypeBFracturesMostDifficult
8、TypeB1StableImplantNoBoneLossORIFVsRevision???+/-CorticalOnla
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