Vancouver B型股骨假体周围骨折的处理

Treatment of type Vancouver B periprosthetic femoral fractures

目的探讨人工髋关节置换术后Vancouver B型股骨假体周围骨折(PFF)的治疗方法的选择及临床效果。方法回顾分析本组1998年～2011年收治的21例Vancouver B型PFF患者,依照Vancouver分类系统,其中12例B1型骨折,6例B2型骨折,3例B3型骨折。分别根据假体稳定性等实施骨折内固定处理或假体翻修手术。内固定处理根据骨折部位及骨折类型使用钢丝捆扎、钢板加钢丝捆扎、异体结构骨加钢丝或钢缆等,假体翻修手术使用常规股骨柄和组合式股骨柄假体。随访时评价患者康复情况,总结分析各种治疗方法的结果。结果所有病例平均随访5.2年。B1型骨折愈合率较高,但需要注意固定钢板长度及复位情况。B2型骨折均行翻修手术,并行骨折内固定处理,需要注意翻修假体的选择。B3型骨折复杂,骨质缺损严重,多需要植骨,预后很差。结论髋关节置换术后PFF较难处理,预防尤为重要,治疗方式的选择取决于骨折部位、假体稳定性及骨量缺损情况,恰当的治疗方式及手术技术是治疗此类骨折的关键,因此术前充分评估计划非常重要。

Objective To discuss the treatment options and clinical results of Vancouver B periprosthetic femoral fractures following hip arthroplasty. Methods 21 patients with Vancouver B periprosthetic femoral fractures treated in the affiliated hospital of Qingdao university medical college from 1998 to 2011 were retrospectively reviewed. Among them,12 cases were type B1 fractures,6 cases were type B2,3 cases were type B3 according to Vancouver classification, which were implemented treatment according to the prosthesis stability fracture fixation treatment or protsthesis revision surgery. The rehabilitation of patients in follow-up study were evaluated, and the treatment results were reviewed and analysed. Results All patients were followed up with an average of 5.2 years. Type B1 fractures healing rate was higher, but we need to pay attention to the length of the fixed plate and the reduction of fractures. The successful revision surgery is the key point of the treatment of type B2 fracture. In complicated B3 fractures, high failure rate was noted. Conclusions Femoral periprosthetic fractures of hip arthroplasty are difficult. Thus, the prevention is particularly important. The choice of treatment depends on the fracture site, implant stability and bone defects. The appropriate treatment and surgical techniques are the keys for the treatment of the fractures, therefore considerate algorithm of preoperative planning for these diseases is very important.