CAJ | 학술논문

背景：全膝关节置换后股骨假体周围骨折与骨质疏松、骨缺损、假体、患者脆弱以及高并发症发生率等因素有关，其防治较困难。 　　目的：综合近几年的文献以探讨全膝关节置换后股骨假体周围骨折的危险因素、分型、治疗、康复及预防。 　　方法：应用计算机分别检索 PubMed 和Spinger Link数据库相关文献，检索时间分别设定为1990年1月1日至2011年12月31日和1980年至2011年，检索词设定为“periprosthetic fracture, knee”，检索语言设定为英语，共检索到626篇文章。 　　结果与结论：按纳入和排除标准对文献进行筛选，共纳入40篇文章。结果表明，随着全膝置换在临床中的广泛开展，股骨假体周围骨折的发生率正在逐年增高，因其预后较差，所以要重视其预防，这一骨折的危险因素包括患者自身内在的难以控制的因素和固定技术等外在因素。Rorabeck 分型是全膝置换后股骨假体周围骨折最常用的分型方法，但其在临床应用中并不理想；Kim分型将会更有效的指导临床。股骨假体周围骨折的治疗包括非手术治疗、切开复位内固定、逆行髓内钉以及翻修等，合适治疗方案的选择主要取决于骨折的类型、局部骨质量、患者的健康状况等，目前尚缺乏完美的原则来指导选择合适的治疗措施，置换后早期功能锻炼将有益于预防固定过久引起的相关并发症及关节功能的丢失。因此，全膝关节置换后股骨假体周围骨折的治疗要严格把握适应证，在牢固固定的同时，应该尽量鼓励患者早期功能锻炼。
배경：전슬관절치환후고골가체주위골절여골질소송、골결손、가체、환자취약이급고병발증발생솔등인소유관，기방치교곤난。 　　목적：종합근궤년적문헌이탐토전슬관절치환후고골가체주위골절적위험인소、분형、치료、강복급예방。 　　방법：응용계산궤분별검색 PubMed 화Spinger Link수거고상관문헌，검색시간분별설정위1990년1월1일지2011년12월31일화1980년지2011년，검색사설정위“periprosthetic fracture, knee”，검색어언설정위영어，공검색도626편문장。 　　결과여결론：안납입화배제표준대문헌진행사선，공납입40편문장。결과표명，수착전슬치환재림상중적엄범개전，고골가체주위골절적발생솔정재축년증고，인기예후교차，소이요중시기예방，저일골절적위험인소포괄환자자신내재적난이공제적인소화고정기술등외재인소。Rorabeck 분형시전슬치환후고골가체주위골절최상용적분형방법，단기재림상응용중병불이상；Kim분형장회경유효적지도림상。고골가체주위골절적치료포괄비수술치료、절개복위내고정、역행수내정이급번수등，합괄치료방안적선택주요취결우골절적류형、국부골질량、환자적건강상황등，목전상결핍완미적원칙래지도선택합괄적치료조시，치환후조기공능단련장유익우예방고정과구인기적상관병발증급관절공능적주실。인차，전슬관절치환후고골가체주위골절적치료요엄격파악괄응증，재뢰고고정적동시，응해진량고려환자조기공능단련。
BACKGROUND:Periprosthetic femoral fracture after total knee arthroplasty is related with the osteoporosis, bone defects, prosthesis, frail patients and high complication rate, so it is difficult to prevent and treat. OBJECTIVE:To explore the risk factor, classification, treatment, rehabilitation and prophylaxis of periprosthetic femoral fracture after total knee arthroplasty based on the reviewed and summarized articles published in recent years. METHODS:A computer-based online search was conducted in PubMed database from January 1, 1990 to December 31, 2011 and in SpringerLink database from 1980 to 2011 for the related articles with the key words of“periprosthetic fracture, knee”in English. A total of 626 articles were retrieved. RESULTS AND CONCLUSION:According to inclusion and exclusion criteria, the articles were screened and 40 articles were included final y. The results showed that with the extensive development of total knee arthroplasty, the incidence of periprosthetic femoral fracture was increased gradual y;due to the poor prognosis, we should pay attention to the prevention. The risk factors of periprosthetic femoral fracture included patients’ internal factor that was hard to control, and some external factors such as the surgical techniques. Rorabeck classification was commonly applied for periprosthetic femoral fracture after total knee arthroplasty, but it was not perfect in clinical application. Kim classification wil be better for clinical guidance. The treatment of periprosthetic femoral fracture included nonoperative treatment, open reduction and internal fixation, retrograde intramedul ary nailing and revision arthroplasty. An appropriate treatment is chosen depending on fracture classification, local bone quality, patients’ medical and nutritional status. At present, however, there is not a perfect guideline for the selection of appropriate treatment method. But the early functional exercise is beneficial to prevent the related complications caused by longtime immobilization and the loss of joint function. Therefore, the indications must be under strict control in the treatment of periprosthetic femoral fracture after total knee arthroplasty. Except the firm fixation, early exercise for the patients should be encouraged at the same time.