【专题文献】之人工髋关节置换——下肢假体周

【专题文献】之人工髋关节置换——下肢假体周围骨折的处理

【专题文献】之人工髋关节置换

宋兵乙

宋兵乙

飘洋过海

MINI-SYMPOSIUM: REVISION HIP SURGERY

小讲座：髋关节翻修术之七

(vii) Management of periprosthetic fractures in the lower limb

(vii) 下肢假体周围骨折的处理

Panos Makrides;Harpal Singh Uppal;Steve Krikler

Abstract

The incidence of periprosthetic fractures is rising significantly as more replacement arthroplasties are performed. They are a potentially devastating complication associated with high morbidity and mortality. Their management is a sub-specialty in itself. This article outlines the principles of the management of periprosthetic fractures of the lower limb.

Keywords bone graft; internal fixation; peri-prosthetic fracture

摘要

当实施了更多的关节置换手术，假体周围骨折的发生正在显著增加。这是潜在的毁灭性的并发症，伴随着很高的发病率和死亡率。其处理本质上是一个亚专业。本文列举了下肢假体周围骨折的处理原则。

关键词：骨移植，内固定，假体周围骨折。

Introduction

An aging population with higher standards of living has led to a steady increase in replacement arthroplasties in developed countries as recorded by the Scandinavian, Australian, UK and Mayo Clinic Registers. The positive outcome of an otherwise successful procedure can be compromised by a periprosthetic fracture (PPF). It is a major problem, associated with high rates of morbidity and mortality.1,2 The prevalence is difficult to ascertain but the consensus is that they are increasing both numerically and in complexity. In 2006 Lindahl et al. reported the cumulative incidence of periprosthetic hip fractures as 0.4%.3 According to the Swedish Hip Registry, PPF is the third commonest reason for revision arthroplasty, after aseptic loosening and dislocation.4 Periprosthetic fractures around a total knee arthroplasty are less common but equally important. They are more common in the distal femur (0.3e2.5%) compared with the proximal tibia (0.39% to 0.5%).

引言：

老年人群，由于更高生活标准，导致发达国家的人工关节置换稳步上升，如同斯堪的那维亚，澳大利亚，英国和梅奥医院登记处（美国）所记录的。一个成功手术的好结果，能被假体周围骨折（PPF）所危害。这是一个大问题，伴随着很高的发病率和死亡率。患病率很难去查明，但并发症在数量和复杂程度上正在增加，这是一致意见的。在2006年，Lindahl等报道了假体周围骨折的累积发病率为0.4%。根据瑞典髋关节登记中心，PPF是翻修的第三常见的原因，排在无菌性松动和脱位之后。在全膝置换的假体周围骨折不常见，但是同样重要。相对于胫骨近端（0.39－0.5%），全膝置换的假体周围骨折更常见于股骨远端（0.3－2.5%）。

Periprosthetic fractures can be divided into those occurring intra-operatively and post-operatively. Intra-operative fractures are usually caused by the insertion of the stem in the femur or the tibia. The incidence varies with different fixation methods. In the femur, uncemented stems carry a higher risk; Berry et al. report a rate of 0.3% in cemented and 5.4% in uncemented. The rates are significantly