温哥华B3型股骨假体周围骨折的手术疗效

Outcome of operative treatment for Vancouver B3 periprosthetic femoral fracture

目的分析温哥华B3型股骨假体周围骨折的手术疗效。方法12例温哥华B3型股骨假体周围骨折患者,根据骨折的稳定性和骨骼质量不同,分别采用长柄非骨水泥假体翻修结合异体骨结构性植骨,使用记忆合金环抱器、钢缆钢板和LISS钢板等进行内固定。结果平均随访时间7.5年。9例患者达到骨性愈合,平均愈合时间4.5个月,未出现假体再松动征象;1例因为感染难以控制而取出假体;1例LISS钢板固定失败;1例患者仍在随访中。结论手术治疗温哥华B3型股骨假体周围骨折的关键是长柄股骨假体翻修、异体皮质骨结构性植骨和牢固的内固定。

Objective To analyse the outcome of operative treatment for Vancouver B3 periprosthetic femoral fracture. Methods Twelve patients with Vancouver B3 periprosthetic femoral fracture were enrolled. Long stem revision with strut of cortical allograft was performed, and shape memory alloy sleeve clamp, cable plate and LISS plate were used for internal fixation depending on the stability of the fracture and quality of bone. Results The mean time of follow-up was 7.5 years. Solid union of fracture was achieved in 9 cases with a mean healing time of 4.5 months, and no loosening of the prosthesis recurred. Two cases experienced failure, one of whom had both the prosthesis and implant removed after repeated debridement due to severe infection, and the other was treated with LISS and ended with hardware failure. The remaining one was still under follow-up. Conclusion The key points of operative treatment for Vancouver B3 femoral periprosthetic fracture are revision with long stem, strut of cortical allograft and rigid internal fixation