老年髋关节置换术后股骨侧假体周围骨折的治疗

目的 探讨老年人工髋关节置换术后发生股骨侧假体周围骨折的治疗。 方法 2005年3月至2011年5月收治的27例75岁及以上的股骨假体周围骨折并行手术治疗的患者，男11例，女16例。股骨假体周围骨折距初次关节置换手术时间为7～83个月，平均63个月；Vanconver分类,A型5例，采用“8”字钢丝捆绑技术；B型19例，选择加长柄技术，锁定钢板技术，环抱器技术；C型3例，采用植骨及钢板固定技术；患者均获得随访9～25个月，平均16个月。采用Harris髋关节功能评分，X线片对治疗结果进行评估。 结果 22例患者骨折愈合；5例患者骨折愈合欠佳，经再次植骨固定，其中3例骨折处愈合，2例能保持假体和肢体结构稳定。14例患者能自由行走；9例需用助行器；4例能在床上自如活动。末次随访Harris评分52～93分，平均76分。 结论老年患者发生股骨假体周围骨折，应根据患者的身体状况，骨折不同类型，以实用可靠为治疗原则。

Treatment of femur periprosthetic fracture after total hip arthroplasty in elderly patient

Objective To discuss treatment experiencing in femur periprothetic fracture after hip arthroplasty in pre-, intra- and post-surgery.Methods From March 2005 to May 2011, 27 patients (11 males, 16 females) aged ＞75 years with femur periprothetic fracture after hip replacement were studied. The mean time from primary hip replacement to femur perprosthetic fracture was 63 months(ranging from 7 to 83 months). According to vanconver classification, type A applying steel wire of character for 8 bind technique was 5 cases, type B applying prolonging stem technique locking compress plate (LCP)technique surrounding instrument technique was 19 cases and type C applying bone graft and plate fixation technique was 3 cases. All patients were followed up from 9 to 25 months (average, 16 months). The results of treatment were evaluated by Harris score and X rays. Results Bony heal was obtained in 22 patients and was not obtained in five cases among whom bony heal occurred in 3 cases and 2 patients could only keep prothetic and limb stable after receiving the bone graft once more. Walking was free in 14 cases,9 cases needed assistant walking instrument,and only 4 cases stayed in the bed freely. Harris score for last follow-up was 52 to 93 (mean 76).Conclusions Based on the patient general status, the fracture types and practical and stable principle, the effective methods can get good results in the treatment of femur periprosthetic fracture in aged patient.