摘要目的 探讨人工全髋关节置换术中及术后股骨干骨折使用捆绑带固定的治疗方法及临床疗效.方法 回顾性分析1999年8月至2007年9月由同一术者连续进行的人工全髋关节置换术(包括翻修手术)2186例,发生术中及术后股骨干骨折22例,其中术中骨折12例,术后外伤骨折10例.男性10例,女性12例,初次置换术9例,翻修术13例.Vancouver骨折分型为B1型骨折15例,B2型骨折7例,并且均为斜形骨折.处理方法为切开骨折复位,根据骨折长度和范围采用2～5根钛制捆绑带环形捆扎,其中13例选用2根,7例选用3根,1例选用4根,1例选用5根.同时根据术中原假体稳定性决定是否更换,其中15例B1型骨折和1例B2型骨折患者术中未予更换股骨柄假体,另外6例B2型骨折患者因股骨假体松动给予更换同类型的加长柄假体.结果 所有患者术后平均18周(12～ 20周)时X线片显示骨折愈合.术后随访4～11年(平均6.5年),髋关节Harris评分80～ 95分(平均90分),髋关节活动度105°～135°(平均120°).股骨假体固定良好,无下沉,无明显透亮线及松动迹象.结论 全髋关节置换术中及术后发生股骨干斜形骨折时可采用捆绑带固定,如果股骨柄假体稳定及分型为B1型骨折时不更换原假体,如果假体柄不稳定分型为B2型时直接更换同类型的加长柄假体,可获得骨折处的坚强固定和股骨柄假体良好的初始稳定性,中长期随访临床效果满意.

abstractsObjective To discuss the treatment and clinical result of using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty.Methods From August 1999 to September 2007,twenty-two patients who suffered from intro-and post-perative femoral oblique fracture in total hip arthroplasty were reviewed among 2186 consecutive total hip arthroplasty patients performed by one surgeon.There were 12 fractures occurred intraoperative and 10 fractures postoperative.There are 9 primary and 13 revision total hip arthroplasty patients including 10 men and 12 women.All fractures are classified as Vancouver B1 type in 15 cases and B2 type in 7 cases.Two to five titanium cerclage bands had been used to fix the fracture followed by open reduction with 13 cases using 2 cerclage bands and 7 cases using 3 bands and 1 case using 4 bands and 1 case using 5 bands.Whether change the original stem or not depended on the classification of fractures and stability of stems.There were 15 cases of type B1 and 1 case of type B2 without changing stems and 6 cases of type B2 changing to revision stems of the same series of original stems.Results All fractures showed successfully union for 12-20 weeks (average 18 weeks) after operation.The average Harris score of the hip improved to 90 points (80 to 95 points) at an average 6.5 years follow-up (4 to 11 years) and the average range of motion of the hip got to 120° (105°-135°).Femoral prosthesises were well-fixed without any subsidence or lucent lines or loosening.All patients were satisfied with the results with well-fixed and good alignment of femoral stem.Conclusions Strong fixation of the fractures and good initial stability of femoral stem can be obtained using titanium cerclage bands to fix the intra- and post-operative femoral oblique fracture.Original stems should be changed to revision stems in case of type B2 and be retained in case of type B1.