髋关节置换术后股骨假体周围Vancouver B型骨折的治疗

Treatment of Vancouver type-B periprosthetic femoral fractures after total hip arthroplasty

目的研究全髋关节置换术后股骨假体周围Vancouver B型骨折的治疗效果。方法股骨假体柄周围骨折10例,其中Vancouver分类B1型3例,B2型2例,B3型5例。B1型骨折行切开复位,异体皮质骨板移植加钢丝环扎治疗；B2型骨折行切开复位,钢丝或线缆固定,加长股骨柄翻修；B3型骨折行切开复位,加长股骨柄翻修,异体皮质骨板移植加钢丝环扎固定。全部患者均得到随访,时间8～36个月,平均27个月,采用Harris髋关节功能评分和X线片对治疗结果进行评价。骨折愈合,患肢恢复行走功能为治疗成功,而骨折未愈合、假体松动、发生感染等并发症需要再次手术治疗者为治疗失败。结果10例患者骨折全部愈合,假体无松动、感染等并发症,治疗成功率100%。9例患者自由行走,1例需要助行器帮助。最后一次随访,Harris评分平均为83分。移植骨板与宿主骨骨性愈合,股骨皮质厚度增加3～5 mm。结论假体稳定性和局部骨骼条件是影响Vancouver B型骨折治疗效果的重要因素,针对髋关节置换术后假体柄周围Vancou- vet B型骨折不同亚型采用不同的治疗方法能够取得很好的疗效。同种异体皮质骨板移植重建股骨假体周围骨折,不但能提供固定支撑作用,而且可促进骨折愈合,增加局部骨量和改善骨强度,显示出较好的优越性。

Objective To study treatment of Vancouver type-B periprostbetic femoral fractures after total hip arthroplasty. Methods There were 10 cases with Vancouver type-B periprosthetic femoral fractures after total hip arthroplasty being treatment, including three cases with type-B1 undergone open reduction and allograft strut to fix the fracture, two with type-B2 undergone open reduction and revision with a long stem and five with type-B3 undergone open reduction, revision with a long stem and allograft strut to restore hone. The mean duration of follow-up was 27 months （8-36 months）. The Harris Hip Score and radiographs were used to evaluate the outcome. Failure of the procedure, was defined as the need for revision surgery because nonunion of fracture, implant loosening, and infection. Results All cases obtained successful fracture healing, with no stem loosening or infection. Of all, nine cases were able to walk by themselves but one needed aid in walking. The Harris Hip Score was 83 at the time of the final follow-up. Osseous union of the allograft to the host femur occurred in eight hips and mild graft resorption in two. The cotex thickness of host femur was increased more than 3-5 mm. Conclusions Stem stability and bone quality are important factors determining the outcome of treatment for periprosthetic femoral fracture after hip arthroplasty. Good outcome can be achieved by adopting different treatments according to sub-classification of Vancouver type-B fractures. The allograft strut for the treatment of a Vancouver type-B periprosthetic femoral fracture can not only provide fixation, but also make fracture heal fast and augment bone mass and Strength.