生物型长柄假体治疗全髋关节置换术后股骨假体周围VancouverB2、B3型骨折

Treatment of Vancouver type-B2\B3 periprosthetic femoral fractures after total hip arthroplasty with long stem un-cemented femoral prostheses

目的研究生物型长柄假体治疗全髋关节置换术后股骨假体周围Vancouver B2、B3型骨折的效果。方法2005年12月至2008年3月期间我科共收治12例行人工全髋关节置换手术后假体周围Vancouver B2、B3型骨折患者,其中Vancouver B2型7例,Vancouver B3型5例,男8例,女4例,69～82岁,平均74.83岁。均采用骨折切开复位,生物型长柄假体翻修、植骨加钛丝环扎固定的手术方法治疗。并对该12例病例进行回顾性分析。结果12例患者均获得术后随访10～32个月,X线显示缺损的骨量均得到明显的恢复,骨折线消失,宿主骨与移植骨已达到骨性愈合。无假体松动、感染和再骨折等常见并发症。末次随访,Harris评分平均为87.83分,其中优(>90分)6例,良(80～89分)6例,无中、差(<80分)病例,优良率达到100%。结论生物型长柄假体翻修、植骨加钛丝环扎固定是治疗全髋关节置换术后股骨假体周围Vancouver B2、B3型骨折的有效方法。

Objective To analyze the treatment effect of Vancouver type-B2／B3 periprosthetic femoral fractures after total hip arthroplasty with long stem uncemented femoral prostheses.Methods Twelve patients with periprosthetic femoral fractures after total hip arthroplasty from December 2005 to March 2008 were studied,including 8 males and 4 females,aged 69-82 years,74.83 years on average.According to the classification of Vancouver,there were 7 cases of type B2 and 5 cases of type B3.All cases were treated with long stem uncemented femoral prostheses revision plus allograft cortical strut bone.Results Twelve cases were followed up for 10-32 months.X-ray showed that the lost bone was obviously recovered,the fracture line disappeared,and the host bone and bone graft achieved bony union.There was no stem loosening,infection or fracture.Hip functions were evaluated by the Harris score,and the mean Harris score was 87.83,excellent（90） in 6 cases,good（80~89） in 6 cases,and fair and poor in none（80）.100% of them obtained excellent or good scores.Conclusion Using long stem uncemented femoral prostheses with allograft cortical strut bone is an effective method for treating Vancouver type-B2／B3 periprosthetic femoral fractures after total hip arthroplasty.