Vancouver B1型股骨假体周围骨折的手术治疗

Surgical treatment of Vancouver type B1 periprosthetic femoral fractures

目的探讨VancouverB1型股骨假体周围骨折的理想手术治疗方式。方法2000年3月至2008年1月,12例Vancouver B1型股骨假体周围骨折患者行切开复位、内固定治疗。男2例,女10例;年龄62～85岁,平均72岁。内固定方式包括LISS锁定接骨板系统、加压接骨板系统,部分病例结合使用多道钢丝或钢缆捆扎固定,及异体柱状皮质骨和(或)DBM人工骨植骨。对术后骨折延迟愈合患者行自体骨髓灌注等治疗。结果患者均获得随访,随访时间12～96个月,平均32个月。除1例术后发生骨折移位失败外,骨折均愈合,愈合时间3～12个月,平均4.3个月。Harris评分:65～92分,平均79分。结论Vancouver B1型股骨假体周围骨折发生率高,处理棘手。目前,LISS系统是治疗此类骨折最有效的方式之一,应尽量使用微创技术以减少骨折处的血供破坏,如需切开整复骨折,应常规植骨,必要时术后可于骨折处定期灌注自体骨髓以促进骨愈合。

Objective To explore the ideal surgical treatment for Vancouver B1 type of periprosthetic femoral fractures. Methods Totally 12 cases of Vancouver B1 type of periprosthetic femoral fractures admitted from March 2000 to January 2008 were reviewed. Internal fixation materials include LISS plate and compressive plate. Multiple steel wires or cables were used to bundle fractures up in some cases. And cortical strut allografts and/or DBM bone transplantation were also used in some cases. Autologous bone marrow transplantation was considered as an effective method for some cases with delayed union of fracture. Results Except for one case with fracture displaced after operation, other 11 cases were fol- lowed up 32 months in average （ 12 to 96 months） with good bone union. The time from operation to bone union was 4. 3 months in average （3 to 12 months）. The mean Harris scores of these patients was 79 points （65 to 92 points）. Conclusion Vancouver B1 type of periprosthetic femoral fracture has a high risk of incidence and it is difficult to deal with. LISS plate is one of satisfied internal fixation materials for this fTacture so far. Less invasive techniques should be applied to pro- tect blood supply of bone as possible as it can. If open reduction needed, it is necessary to do bone transplantation in frac- ture area routinely. To some cases with delayed bone union, autologous bone marrow can be transplanted into the fracture area in a regular time.