目的：探讨全膝关节置换术后股骨假体周围骨折的治疗方法及疗效。方法收集我院2010年5月至2014年5月收治的13例膝关节假体周围骨折病例，均为 Rorabeck Ⅱ型（Kim ⅠB 型），其中男5例，女8例，年龄58~79岁，平均年龄66.9岁。13例均采用解剖型股骨髁锁定钢板固定，其中7例联合异体皮质骨板钢丝捆扎固定。结果所有患者均获得随访，平均随访时间23.3个月。术后1个月时HSS评分平均（71.2±6.0）分，半年时平均（91.6±4.1）分，末次随访时平均（94.1±2.6）分。所有病例无内固定失败情况发生，至术后第6个月随访时骨折均达临床愈合，未见假体松动，膝关节屈伸功能良好，活动度可达90°~120°，无明显疼痛。结论对假体稳定的膝关节置换术后股骨假体周围骨折采取解剖型股骨髁锁定钢板；对假体稳定的，但骨质条件差、骨质疏松、粉碎股骨假体周围骨折采取解剖型股骨髁锁定钢板结合异体皮质骨板捆扎可获得良好的术后效果。%Objective To explore the treatment of the periprosthetic femur farctures after a total knee arthroplasty. Meth-ods 13 cases of periprosthetic femur fractures after a total knee arthroplasty from May 2010 to May 2014 in the department of orthopedic surgery of West China Hospital were treated,including 5 males and 8 females with an average age of 66. 9 years (range,58 ~ 79 years). All were type Ⅱin the Rorabeck classification(type ⅠB in the Kim classification)and were treated with anatomical femoral condyle plate. Among them,7cases were treated combined with cortical bone plate allografts. Results All cases were followed with an average of 23. 3 months. The average HSS score was 71. 2 ± 6. 0 one month after the surgery. Half a year after the surgery,the average HSS score was 91. 6 ± 4. 1. At the last follow-up,the average HSS score was 94. 1 ± 2. 6. X-ray showed that bone union was achievedof all patients. Until the last evaluation,there were no any complications of loosening,or fixation failure. All patients had no complain of pain in knee,which were functioning well with a range of motion about 90 degree to 120 degree. Conclusion Anatomical femoral condyle plate for periprosthetic femur fractures after a total knee arthroplasty with good bone stock,stable and well postioned prosthesis and cortical bone plate allografts combined with an-atomical femoral condyle plate for comminuted periprosthetic femur fractures after a total knee arthroplasty with stable and well postioned prosthesis can gain satisfied outcomes.
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