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ID:19742859
大小:13.09 MB
页数:25页
时间:2018-10-05
《假体周围骨折的分型与治疗方案ppt课件》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、PeriprostheticFracturesClassificationandTreatmentIncreasingNumbersMoreArthroplastiesMoreInternalFixationOsteoporoticFracturesMoreIndependentElderlyMoreRevisionsIncidenceIncreasingBetween1987–2003Incidence0.14%Between2004–2007Incidence0.78%?????????EarlierMobilizationSmallerIncisionsProximal
2、lyCoatedStems?????????Berryet.al.2007“…itisbecomingalittlebitofaminiepidemic.”D.Berry,MDIntraoperativeFractureCementedHipStem<1%incidenceoffractureCementlessHipStem3%-20%incidenceoffractureRevisionarthroplasty6.3%withcementedstem17.6%withcementlessstemIntraoperativeFractureRiskFactorsCement
3、lessImplantRevisionSurgeryDecreasedBoneStrengthOsteoporosisRaDeformitySurroundingImplantIntraoperativeFractureTreatmentFractureProximalToLesserTrochanterCablesCollaredImplantPerforationsLongerStem-bypassPerforationBy21/2CanalDiameters+/-SupplementalBoneGraftingPeriprostheticFracturesRiskFa
4、ctorsDecreasedbonestrengthPerforationsLoosestemOsteolysisStressrisersScrewholesTreatmentGoalsUnitedFractureAnatomicAlignmentStableProsthesisEarlyMobilizationReturnToPreviousFunctionTreatmentManyOption/PermutationsNon-operativeRevisionArthroplastyAnd/OrORIFAnd/OrStrutGraftingNoClearConsensusE
5、achCaseMustBeIndividualizedCriticalFactorsStabilityOfTheProsthesisLocationOfTheFractureRelativeToProsthesisQualityOfBonePatientAgeMedicalConditionBaselineStatusVancouverClassification(FracturesAboutTHAStems)ConsiderationsLocationOfTheFractureImplantStabilityBoneQualityVancouverClassificatio
6、nTypedeterminedbylocationTypeATrochantericregionTypeBAbouttipofstemTypeCDistaltotipofstemTypeB(AtTip)SubClassificationTypeB1ImplantIsStableTypeB2ImplantIsLooseSatisfactoryBoneTypeB3ImplantIsLooseInadequateBoneStockTreatmentTypeA-TrochantericRegionUsuallyStableProtectedWBORIFCablesPlatePlate
7、+CablesVancouverTypeCTreatmentORIFAvoidStressRiserBetweenImplantsOverlapFixationDeviceWithImplantMaintain>2½CorticalDiametersBetweenDevicesTreatmentVancouverTypeBFracturesMostDifficultTypeB1StableImplantNoBoneLossORIFVsRevision???+/-CorticalOnla
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