Kalça protezi çevresi femur kırığı

Özet

Kalça artroplastisi olan hastada femur kırığı, travma sonrası veya zayıflamış periprostetik kemikte düşük enerjili olayla gelişebilir. BT, kemik algoritması ve metal artefakt azaltma (MAR) teknikleriyle birlikte komponent gevşekliği, çimento mantosu bozulması ve osteolizi değerlendirmede radyografiyi tamamlar; ancak metal artefaktlar tanıyı kısıtlayabilir. Vancouver sınıflaması kırığın seviyesini stem stabilitesi ve kemik stoğu ile birlikte tanımlar; stem stabilitesi BT'den kesinleştirilemeyebilir. Stem çevresindeki kırığın ve loosening işaretlerinin atlanması kırık sınıflamasını ve cerrahi planlama iletişimini bozar.

Faz ve pencere

Kontrastsız tanısal

Metal artefakt azaltmalı kemik algoritmasında femoral stem ve ucu, trokanterler, kırık hattı, kortikal parçalanma, deplasman ve çevre kemik kaybı görülür; kırık kemik morfolojisi için kontrast gerekmez.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Büyük trokanter veya küçük trokanter avulsiyon tipi kırığı stem çevresinden ayrı olarak tarif edilir.
• Stem çevresindeki kırık hattı stem ucu seviyesine göre uzar; tüm implant boyunca kırık B bölgesi paternidir.
• Stem ucunun belirgin distalindeki femur kırığı Vancouver C yerleşimine uyar.
• Uzun oblik veya spiral kırık hatları, transvers kırıklar ve komponent çevresinde komminüasyon gözlenebilir.
• Stem çevresi osteoliz, kortikal incelme, implant migrasyonu veya çimento mantosu bozulması gevşek stem olasılığını artırır.
• Medial kalcar, proksimal kemik stoğu ve karşı korteksin kalan kalınlığı kırık çevresi kemik desteğini gösterir.

Ölçütler ve sınıflamalar

Vancouver sınıflaması

A: trokanterik bölge (AG büyük, AL küçük trokanter); B: stem çevresinde veya hemen distalinde (B1 stem sabit, B2 stem gevşek ve kemik stoğu iyi, B3 stem gevşek ve kemik stoğu kötü); C: stem ucunun belirgin distalinde kırık. Vancouver femur çevresi kırıklarda hâlen yaygın kullanılan sistemdir; Unified Classification System (UCS) periprostetik kırıklar için daha geniş bir çerçeve sunar. BT kırık yerleşimini gösterir, ancak stem stabilitesi ve kemik stoğu her zaman BT ile kesinleştirilemez.

Normalde

Normal, kırılmamış periprostetik femurda stem femur kanalına oturur, çevre korteks devamlıdır ve implant çevresinde yeni fokal kemik kaybı yoktur. Kırık seviyesini stemin proksimal ucu, gövdesi ve distal ucu ile eşleştir; aynı zamanda karşı korteks, trokanterler ve önceki görüntülerdeki implant konumunu incele.

Ayırıcı tanı

Metastatik patolojik kırık

kırık hattı medüller metastatik tümör odağından geçer.

Femur yetmezlik kırığı

uzun süreli bisfosfonat kullanımıyla ilişkilendirilen stres tipi kırıklardır; genellikle kortikal kalınlaşma ve minimal travma mekanizması gösterir.

İntraoperatif veya gizli femur kırıkları; kanal hazırlaması veya komponent yerleştirme sırasında ortaya çıkabilir, radyografide görünmeyerek sadece BT ile tespit edilebilir.

Protez çevresi enfeksiyon

endosteal düzensiz osteoliz, periostal reaksiyon veya yumuşak doku koleksiyonu kırığa eşlik edebilir.

Tuzaklar

• BT'de kırık stem çevresinde diye B1 ve B2 ayrımını kesinleştirme; stem gevşekliği cerrahi veya seri görüntüleme ile anlaşılabilir.
• Metal implantler tarafından oluşturulan artefaktlar kemik-yumuşak doku ara yüzünü bulanıklaştırabilir; tanı güvenliğini artırmak için metal artefakt azaltma (MAR) algoritmaları kullanılmalıdır.
• Küçük trokanter kırığını sıradan avulsiyon olarak bırakma; medial kalcar uzanımı ve femoral stem desteğini değerlendir.
• Kırık düzeyini yalnız kalça eklemi alanında raporlama; tüm stem ve distal ucun taramaya dahil olup olmadığını belirt.

Kendini dene

1. Kırık stem gövdesini çevreliyor ve stem ucu düzeyinde sonlanıyor. Stabil stem varsayımıyla Vancouver tipi nedir?

   • Vancouver AG
   • Vancouver B1
   • Vancouver B3
   • Vancouver C
   Cevabı göster

   Vancouver B1. Stem çevresindeki kırık B grubudur; stem sabitse B1 olarak sınıflanır. AG büyük trokanter, B3 gevşek stem ve kötü kemik stoğu, C ise stem ucunun distalindeki kırığı tanımlar.

2. Kırık stemin belirgin distalinde, femur şaftında yer alıyor. Vancouver sınıfı hangisidir?

   • Vancouver AL
   • Vancouver B2
   • Vancouver B3
   • Vancouver C
   Cevabı göster

   Vancouver C. Stem ucunun distalindeki kırık Vancouver C'dir. AL küçük trokanter bölgesidir; B2 ve B3 stem çevresindeki kırıklardır ve gevşek stem varlığında kemik stoğuna göre ayrılır.

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.