Vancouver B型股骨假体周围骨折的手术治疗分析

The Surgical Treatment of Vancouver Type B periprosthetic Femoral Fractures

目的探讨髋关节置换术后股骨假体周围骨折Vancouver B型手术治疗方法的选择。方法对13例股骨假体周围骨折Vancouver B型患者进行手术治疗，3例B1型行切开复位捆绑带或钢板钢缆螺钉内固定治疗；8例B2型患者取出股骨假体后骨折复位内固定，然后置人长柄股骨假体；2例B3型采用结构性异体骨植骨，假体翻修，骨折内固定治疗。结果所有患者均得到随访，随访时间1．5年（1～4．8年）。患者术后没有发生深静脉栓塞，骨折均愈合，无感染、内固定断裂、股骨假体松动或下沉。行假体翻修的B2型和B3型患者Harris评分由术前33分（17～42分）提高到术后85分（78～92分）。结论根据骨折的部位、假体的稳定性和骨质量，选择恰当的治疗方式，是治疗股骨假体周围骨折VancouverB型的关键。

Objective To study the surgical treatment of Vancouver type 13 periprosthetic femoral fractures after hip arthroplasty. Methods 13 cases of Vancouver type B periprosthetic femoral fractures were treated. 3 cases of type B1 were treated by open reduction and fixation with wires or cable plate combined with screws. 8 cases of type B2 and 2 cases of type B3 were treated with long shaft prosthesis revision combined with open reduction and internal fixation or bone grafting respectively. Results All of 13 patients were followed up for 1.5years （1-4.8 years）. Bone healing was obtained in all patients. And there were no complications such venous embolism,infection, fixation breakage and loosen of implants. Harris Score increased significantly from 33 score （17-42 score） preoperation to 85 score （78-92 score） postoperation. Conclusion The methods applied for periprosthetic femoral fractures depend on the site of fracture,stability of implants and quality of bone. The key of the treatment is to chose the appropriate therapy.