解剖柄植入并发股骨近端骨折与股骨近段髓腔解剖-第三军医大学学报.docVIP

解剖柄植入并发股骨近端骨折与股骨近段髓腔解剖分析 Relations between fractures and geometry of proximal femoral when implanting anatomy stem 王敏 张峡 郝勇 周跃 张正丰 李长青 Min Wang, Xia Zhang, Yong Hao, Yue Zhou, Zhengfeng Zhang, Changqing Li 第三军医大学新桥医院骨科400037 Orthopaedic Dept. Xinqiao Hospital, Third military medical university, 400037 摘要：目的：分析Ribbed解剖柄植入并发股骨近端骨折的原因，探讨股骨髓腔解剖因素在股骨近段骨折中的重要影响，为术前正确选择假体类型提供参考。方法：2004年1月-2009年1月，我们共进行了213例254髋手术，采用德国Link公司解剖性假体Ribbed柄。对213例病人的髓腔形态归纳分析，随访时间最短的1年，最长的5年，平均3.6年，髋关节功能采用Harris评分。 结果： 82.63%病人的髓腔形态为正常型，香槟型占9.39%，只有7.98%的病人髓腔为烟道型，术中有11例发生股骨近段的骨折，占手术并发症的26.2%，占本组病例的5.16%，骨折主要发生在香槟型病人中，占63.6%。11例病人的Harris评分由术前的40.8提高到术后的93.0。结论：解剖柄植入时发生股骨近段骨折或植入困难和股骨髓腔的解剖形态有关系，选择解剖型假体时，应该考虑股骨近段的解剖形态。 关键词：解剖柄；股骨近段解剖；股骨近段骨折 Abstract: Object: Analysis the reasons of proximal femoral fracture when implanting the anatomy stem, and discussion the important of geometry basis knowledge of proximal femoral canal in order to get optimal selection for stem prosthesis. Methods: Between Jan.2004 and Jan. 2009, 213 patients with 254 hips have been performed total hip replacement because of diversity reasons, the Ribbed stems of Germany Link company were administrated in the research, we analysis the patients’s proximal medullary cavity of the femur, all the people were followed up from 1 to 5 years, for an average of 3.6 years, the function of hips were evaluated by standard of Harris. Results: 82.63% patients have normal proximal medullary cavity of the femur, 9.39% patients are type Champagne-flute and only 7.98% show the type Stovepipe. 11 cases suffered from the proximal femoral fracture, it was account for 26.2% in all complications and 5.16% in all patients. 63.6% fracture patients’s proximal femoral canals were belong to the type Champagne-flute. The Harris Score were improved remarkably from 40.8 to 93.0 after surgery. Conclusion: the complication of fracture of proximal femoral and implanting hardness were due to proximal medullary canal geometry of the femur, which is the key factor f