假体周围骨折课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Case discussion,蓝余兴 男,63,岁，,3256451,摔伤致右大腿活动受限伴胀痛,4,天,既往：,8,年前右全髋手术，恶性淋巴肿瘤,2,年余，,1,年前放疗史。,PE,：右大腿肿胀，擦伤，压痛明显，右下肢皮牵引,2kg,，活动受限，肢端血供、活动正常，右足背动脉搏动良好，足部感觉麻木，触觉存。,辅检：,X,线：右侧髋关节人工关节植入术后改变。,2.,右股骨上段骨折。,3.,骨盆骨质增生、骨质疏松，左髋关节退变考虑。,诊断：右髋关节置换术后假体周围骨折（,Vancouver B2,型）右髋臼假体周围骨折,处理：右髋关节术后翻修术,Case discussion蓝余兴 男 63岁，32564,假体周围骨折课件,假体周围骨折课件,假体周围骨折课件,Periprosthetic femoral fractures in total hip arthroplasty,Periprosthetic femoral fractur,Fractures around Implants,Pose Unique Fixation Challenges,Fractures around ImplantsPose,Classification,Vancouver,AAOS,ClassificationVancouver AAOS,假体周围骨折课件,Vancouver Type A,Fracture at the trochanters,A,L,at lesser trochanter,A,G,at greater trochanter,Vancouver Type AFracture at th,Vancouver Type B1,Fracture is around or just below a,well-fixed,stem,Vancouver Type B1Fracture is a,Vancouver Type B2,Fracture is around or just below a,loose,stem,Vancouver Type B2Fracture is a,Vancouver Type B3,Fracture is around or just below a stem with,poor proximal femoral bone stock,Vancouver Type B3Fracture is a,Vancouver Type C,Fracture Well Below the Stem,Vancouver Type CFracture Well,Treatment,Treatment,Vancouver type A,Bulletin of the Hospital for Joint Diseases 2013;71(1):68-78,Vancouver type ABulletin of th,Vancouver type B,Bulletin of the Hospital for Joint Diseases 2013;71(1):68-78,Vancouver type BBulletin of th,假体周围骨折课件,假体周围骨折课件,假体周围骨折课件,Vancouver type C,Bulletin of the Hospital for Joint Diseases 2013;71(1):68-78,Vancouver type CBulletin of th,假体周围骨折课件,Problems with Treating Peri-Implant Fractures,Implants may block new fixation devices,Stems,rods,and bone cement may fill the medullary canal preventing IM fixation of fractures,Stems and rods may also block screw fixation through the medullary canal to hold plates on bone,Implants may impair healing,due to endosteal ischemia,Defects in bone,from Osteolysis,Osteoporosis,and Implant Motion,may compromise fixation,Problems with Treating Peri-I,Fixation Methods,Follow,Standard Principles of Fixation,Must Achieve,Stable Anatomic Fixation,while,Preserving Soft Tissue,Attachments,Indirect Reduction Techniques,Careful,Preoperative Planning,Intra-Operative Flexibility/,Creativity,Choose the Device That Fits the Patient,Fixation MethodsFollow Standar,Periprosthetic Femur Fractures,Treatment Options are:,Long-stem revision arthroplasty,Cortical strut allografting,Plate fixation with screws,Plate fixation with cables,Intramedullary Devices,Periprosthetic Femur Fractures,Treatment Options,Most Important Factor,in Treating Peri-Implant Fractures is the,Status of the Implant,Treatment Options Most Importa,When the Implant is,Loose,Mal-aligned or Deformed,Consider,Revision/Replacement,When the Implant is Loose,Ma,When the Implant is,Stable,and Well Aligned with Good Quality Bone,Consider,Fixation,When the Implant is Stable,an,Hip Peri-Prosthetic Fixation,Standard is with Plate or Allograft,or,Hip Peri-Prosthetic Fixation,Plate Techniques May Use Cables to attach the plate to the bone,Cables,Require Extensive Exposure,And are Technically Demanding,So the fewer Used,the Better,:,To decrease operative trauma and operating time,Plate Techniques May Use Cable,Plate Techniques Can Also Use Screws to Attach the Plate to Bone,Screws,Can be Placed Easier than Cables,And Can be Placed Percutaneously with less soft tissue trauma than Cables,So,using Screws instead of Cables should decrease operative trauma and operating time,Plate Techniques Can Also Use,Use of plates with cables:There are many reports,Examples:,-,Ogden and Rendall,Orthop Trans,1978,-Zenni,et al,Clin Orthop,1988,-,Berman and Zamarin,Orthopaedics,1993,-,Haddad,et al,Injury,1997,But none of these address the question:how many cables are necessary?,Use of plates with cables:The,PeriProsthetic Fracture,Cerclage Wires are Less Mechanically Sound than Unicortical Screws,Lohrbach&Rabin MidAmerica Orthopedic Assoc.Annual Meeting 2002,PeriProsthetic FractureCerclag,A unicortical screw significantly increases torsional and A-P stability and should be added to cable-plate constructs,At least six cables are needed in the absence of a unicortical screw to improve A-P and rotational stability,Lohrbach&Rabin MidAmerica Orthopedic Assoc.Annual Meeting 2002,A unicortical screw significan,Case 1:Revision of Loose Prosthesis Complicated by Fracture,82 y/o F,Pre-existing LOOSE Hip Replacement,Fell sustaining Peri-Prosthetic Femoral Shaft Fracture,X-ray Findings:Osteolysis,Case 1:Revision of Loose Pros,Case 1:Revision of Loose Prosthesis Complicated b