假体周围骨折的分型与治疗方案

PeriprostheticFracturesClassificationandTreatmentIncreasingNumbersMoreArthroplastiesMoreInternalFixationOsteoporoticFracturesMoreIndependentElderlyMoreRevisionsIncidenceIncreasingBetween1987–2003Incidence0.14%Between2004–2007Incidence0.78%?????????EarlierMobilizationSmallerIncisionsProximallyCoatedStems?????????Berryet.al.2007“…itisbecomingalittlebitofaminiepidemic.”D.Berry,MDIntraoperativeFractureCementedHipStem1%incidenceoffractureCementlessHipStem3%-20%incidenceoffractureRevisionarthroplasty6.3%withcementedstem17.6%withcementlessstemIntraoperativeFractureRiskFactorsCementlessImplantRevisionSurgeryDecreasedBoneStrengthOsteoporosisRaDeformitySurroundingImplantIntraoperativeFractureTreatmentFractureProximalToLesserTrochanterCablesCollaredImplantPerforationsLongerStem-bypassPerforationBy21/2CanalDiameters+/-SupplementalBoneGraftingPeriprostheticFracturesRiskFactorsDecreasedbonestrengthPerforationsLoosestemOsteolysisStressrisersScrewholesTreatmentGoalsUnitedFractureAnatomicAlignmentStableProsthesisEarlyMobilizationReturnToPreviousFunctionTreatmentManyOption/PermutationsNon-operativeRevisionArthroplastyAnd/OrORIFAnd/OrStrutGraftingNoClearConsensusEachCaseMustBeIndividualizedCriticalFactorsStabilityOfTheProsthesisLocationOfTheFractureRelativeToProsthesisQualityOfBonePatientAgeMedicalConditionBaselineStatusVancouverClassification(FracturesAboutTHAStems)ConsiderationsLocationOfTheFractureImplantStabilityBoneQualityVancouverClassificationTypedeterminedbylocationTypeATrochantericregionTypeBAbouttipofstemTypeCDistaltotipofstemTypeB(AtTip)SubClassificationTypeB1ImplantIsStableTypeB2ImplantIsLooseSatisfactoryBoneTypeB3ImplantIsLooseInadequateBoneStockTreatmentTypeA-TrochantericRegionUsuallyStableProtectedWBORIFCablesPlatePlate+CablesVancouverTypeCTreatmentORIFAvoidStressRiserBetweenImplantsOverlapFixationDeviceWithImplantMaintain2½CorticalDiametersBetweenDevicesTreatmentVancouverTypeBFracturesMostDifficultTypeB1StableImplantNoBoneLossORIFVsRevision???+/-CorticalOnlayStrutGrafting????ConsiderDifficultyofStableImplantRemovalTypeB2andB3FracturesLooseImplantRevisionArthroplastyBoneLossBonegraftCaseExampleInitialCerclageReductionPlateApplicationLongFixationSpanConclusionsVancouverClassificationHelpfulinTreatmentDecisionsIndirectReductionIfPlateUsedCablesandOnlayGraftsHelpfulThinkLONGonPlatesandNailsAlwaysThinkoftheNextOperationThankYou