术中防治人工髋关节置换术假体周围骨折的体会(2)
3.3预防措施对于骨质疏松患者，术前术后给予抗骨质疏松药物治疗，术中打入髓腔锉时动作要轻柔，切忌暴力打入。手术患者术前拍双髋关节正侧位片，包含股骨上段，经测量后确定与之相匹配的假体。对于重度骨质疏松或骨皮质较薄的患者给予钢丝环扎以预防骨折，股骨周围软组织应松解完全，暴露清楚以随时发现有无骨折出现。术中扩髓是要尽量沿其轴线，避免偏斜。扩髓时若遇阻力增大或打入幅度增大，应C臂透视并预防性给予钢丝捆扎术。翻修术中应仔细分离清理骨水泥不可强力打出假体。
3.4治疗措施依据Vancouver假体周围骨折分型给予相应处理，A型骨折属稳定型骨折，一般对假体稳定性影响小。但笔者认为，患者多为中老年人且体质相对较差，长期卧床保守治疗易导致深静脉血栓，褥疮，感染等严重并发症，故根据患者具体情况尽量给予捆绑带或钢丝环扎联合异体骨移植，争取早日下床活动减少术后并发症发生。B型骨折中笔者均使用记忆合金环抱器联合异体人工骨治疗，所选用的环抱器截面内径应略小于所固定的股骨外径，其内径较股骨直径小10%～20%[4]记忆合金环抱器有如下优点：①中固定简便。②中对骨膜损伤较小，大大提高骨折的愈合机率。③定牢固,耐腐蚀、耐磨损。④良好的生物相容性和低生物退变性、无毒、无电解性,可在人体长期存放,可以不二次手术取出[5]。⑤早期活动功能锻炼，大大减少术后并发症的发生率且有利于恢复关节活动功能。C型骨折为假体远端骨折不影响假体稳定，笔者选择微创内固定系统(LISS)钢板联合异体骨植骨，均获得良好的疗效。
参考文献
[1]Mehran Moazena, Alison C. Jonesa, et al. Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing.J Clinical Biomechanics January, 2011, 26(1):3-22.
[2]K Corten, F Vanrykel.An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.J Journal of Bone and Joint Surgery-British, 2009,91(1):1424-1430.
[3]Barton Harris, John R. Owen BS, et al. Does Femoral Component Loosening Predispose to Femoral Fracture? J Clin Orthop Relat Res, 2010,468(2):497-503.
[4]Donald S,Garbuz, MHSc,et al. Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty J Clin Orthop Relat Res, 2010,468 (2):318–325.
[5]Jia-can Su, Xin-wei Liu, Bao-qing Yu, Zhuo-dong Li, et al. Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion J International Orthopaedics, 2010,34(3):369., 百拇医药(丁勇 刘殿鹏 孟宪志)
3.4治疗措施依据Vancouver假体周围骨折分型给予相应处理，A型骨折属稳定型骨折，一般对假体稳定性影响小。但笔者认为，患者多为中老年人且体质相对较差，长期卧床保守治疗易导致深静脉血栓，褥疮，感染等严重并发症，故根据患者具体情况尽量给予捆绑带或钢丝环扎联合异体骨移植，争取早日下床活动减少术后并发症发生。B型骨折中笔者均使用记忆合金环抱器联合异体人工骨治疗，所选用的环抱器截面内径应略小于所固定的股骨外径，其内径较股骨直径小10%～20%[4]记忆合金环抱器有如下优点：①中固定简便。②中对骨膜损伤较小，大大提高骨折的愈合机率。③定牢固,耐腐蚀、耐磨损。④良好的生物相容性和低生物退变性、无毒、无电解性,可在人体长期存放,可以不二次手术取出[5]。⑤早期活动功能锻炼，大大减少术后并发症的发生率且有利于恢复关节活动功能。C型骨折为假体远端骨折不影响假体稳定，笔者选择微创内固定系统(LISS)钢板联合异体骨植骨，均获得良好的疗效。
参考文献
[1]Mehran Moazena, Alison C. Jonesa, et al. Periprosthetic fracture fixation of the femur following total hip arthroplasty: A review of biomechanical testing.J Clinical Biomechanics January, 2011, 26(1):3-22.
[2]K Corten, F Vanrykel.An algorithm for the surgical treatment of periprosthetic fractures of the femur around a well-fixed femoral component.J Journal of Bone and Joint Surgery-British, 2009,91(1):1424-1430.
[3]Barton Harris, John R. Owen BS, et al. Does Femoral Component Loosening Predispose to Femoral Fracture? J Clin Orthop Relat Res, 2010,468(2):497-503.
[4]Donald S,Garbuz, MHSc,et al. Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty J Clin Orthop Relat Res, 2010,468 (2):318–325.
[5]Jia-can Su, Xin-wei Liu, Bao-qing Yu, Zhuo-dong Li, et al. Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion J International Orthopaedics, 2010,34(3):369., 百拇医药(丁勇 刘殿鹏 孟宪志)