【专题文献】之人工髋关节置换——下肢假体周围骨折的处理

定的假体周围骨折，应该考虑外固定。如果病人或能要求较低且假体松动，这时可以考虑Girdlestone手术。 最后，如果缺损非常广泛，应当考虑使用一个大型假体，如在肿瘤切除后使用的那种。股骨于不正常的骨量之下切除，假体固定到远端骨干。外展机制附着于大型假体上。Klein等报道了平均Harris髋评分71分的满意结果。

在髋周的假体周围骨折中，更多的注意力集中于股骨假体，因为髋臼周围的假体周围骨折非常少，但他们可能危急生命。髋臼骨折更常见于术中，但同时，和髋臼假体周围的松动和严重骨溶解有关。明显松动的髋臼窝应当翻修。

Classification of periprosthetic fractures around the knee

Various classifications have been proposed for periprosthetic fractures around the knee. Backstein21 et al. described a system based on the position of the fracture, the bone stock and if the prosthesis was loose (Table 3).

The Rorabeck-Lewis classification is a good guide for management, again based on the condition of the prosthesis22 (Table 4).

膝关节周围PPF的分类

有不同的分类系统用于膝周围假体周围骨折的分类。Backstien等描述了基于骨折位置、骨量和假体是否松动的分类。（表3）

Rorabeck-Lewis分类对于治疗是较好的指导，另一方面基于假体状况（表4）。

表3

表4

Management

If, which is quite rare, the fracture is undisplaced and the prosthesis is stable, non-surgical treatment is appropriate using a brace to restrict joint movement and protected weight-bearing. In most cases surgical treatment is necessary. Fractures more than 15 cm away from the femoral implant should not be considered as periprosthetic and should be managed conventionally. The commonest and most widely