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Re: Вопрос по лечению перипротезного перелома бедр
David Goetz, MD 10 Апрель 2007, 08:46
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Stems you show are fine but removing a well fixed AML stem means an extended trochanteric osteotomy, cutting the stem below its metaphyseal flair, then over reaming the distal piece of prosthesis. Can be done but is difficult, requires specialized equipment, and will create a lot of proximal bone loss and proximal femoral instability. Also, with the fracture, exposure of the hip joint is difficult because you can't rotate the hip by moving the lower leg. This means clamps on the proximal fragment further devascularizing the bone. You will be left with a bag of bone proximally using less than ideal distal fixation to encourage bone ingrowth to your revision prosthesis. Now you need ingrowth AND union.
I would still prefer leaving the well functioning total joint out of the procedure and making a better mechanical and biologic attempt on the
femur.
Dave
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