假体周围骨折的分型与治疗方案.ppt

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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