温哥华B型股骨假体周围骨折的治疗

Treatment for Periprosthetic Femoral Fracture(Vancouver B type)after Hip Arthroplasty

目的:总结温哥华B型股骨假体周围骨折治疗的经验和体会。方法:自2004年2月～2009年8月收治人工髋关节置换术温哥华B型股骨假体周围骨折病人12例,均行手术治疗,包括:单纯钢丝环扎固定2例,普通接骨板固定1例,锁定加压接骨板固定4例,钢板结合钛缆固定1例,形状记忆合金环抱器内固定1例,生物型加长柄股骨假体置换2例,骨水泥型加长柄假体置换1例,术中植骨4例,术后结合石膏外固定1例。结果:术后随访4个月～18个月,平均15个月。11例病人骨折获得骨性愈合,1例股骨假体翻修术中出现骨水泥外溢,随访未出现假体松动临床症状。Harris评分单纯行骨折固定未行股骨假体翻修的病人Harris评分无明显影响,同时行翻修的病人Harris评分明显升高。结论:髋关节置换术中、术后股骨假体周围骨折以VancouverB型骨折多见,术前应根据此型骨折特点全面计划、准备,选择适合的内固定,术中仔细操作,可获满意疗效。

Objective：To summarize the experience of treatment for periprosthetic femoral fracture（Vancouver B type）after hip arthroplasty.Methods：From February 2004 to August 2009,twelve patients with periprosthetic femur fracture（Vancouver B type）after hip arthroplasty were studied.All patients were treated with internal fixation.Two fractures were bundled up merely with steel-wire,one case was fixed with common plate,four cases with locking compress plate（LCP）,one case with tiantium cable combined with plate,one case with shape memory alloy sleeve clamp,two cases with long anatomical stem revision,one case with long stem revision augmented with bone cement,four cases combined bony allograft,and one case combined with external plaster fixation at the same time.Results：All patients were followed up for four months to eight months with average of 15 months.Bony heal was obtained in 11 patients,bone cement extrusion was found in one case with long stem revision augmented with bone cement,then no loosening of the prosthetic recurred.The Harris Score did not change significantly in those who received fracture internal fixation merely without femur stem reversion,and increased significantly in those who received fixation and femur stem reversion at the same time.Conclusion：The emergence of periprosthetic femoral fracture are mainly Vancouver B type after hip arthroplasty.Plan are carefully according to unit characteristic before operation,Open reduction and internal fixation for the treatment of the periprosthetic fracture around femoral implant can successfully restore function for most patients.