大粗隆钢板结合异体皮质骨板治疗Vancouver B3型股骨假体周围骨折

Treatment of Vancouver type B3 periprosthetic femoral fracture with greater trochanter reattachment device and cortical strut bone allograft

目的观察应用大粗隆钢板结合异体骨板对Vancouver B3型股骨假体周围骨折进行人工髋关节翻修的疗效。方法回顾性分析2006年1月～2011年1月采用大粗隆钢板结合异体骨板治疗的Vancouver B3型股骨假体周围骨折患者26例,男5例,女21例,55～79岁,平均63.52岁。所有患者均采用Zimmer大粗隆钢板、钛缆,翻修假体均选用Zimmer Wagner长柄假体。以Harris评分标准对患者术前术后髋关节功能进行评估,通过数字化X线摄片技术对假体稳定性、异体骨板愈合情况进行评估。结果 26例患者随访12～35个月,平均25个月,所有患者骨折均愈合,未出现感染、松动、骨折不愈合及畸形愈合。术前Harris评分为(35.26±3.35)分,术后Harris评分为(84.70±6.21)分,其中优5例,良16例,中5例,优良率80.77%。至随访结束,假体稳定,异体骨板愈合良好。结论应用大粗隆钢板结合异体骨板对Vancouver B3型股骨假体周围骨折进行人工髋关节翻修手术操作简便,并发症少,术后髋关节功能恢复良好,短期临床效果满意。

Objective To analyze the therapeutic effect of Vancouver type B3 periprosthetic femoral fracture after treating with greater trochanter reattachment device （GTR） and cortical strut bone graft in the prosthesis revision of the total hip arthroplasty. Methods A total of 26 patients were selected from January 2006 to January 2011, including 5 males and 21 females, aged 55 -79 years, 63.52 years on average. All the cases were treated by the Zimmer greater trochanter reattachment device （GTR）, and the Zimmer Wagner uncemented long stem. Harris score was used to evaluate the hip functions before and after the operation. Prosthesis stability and the bony union were assessed by the digital radiography. Results All the patients were followed-up for 25 months on average （ 12 - 35 months） after the operation. All the fractures reached union, and there was no infection, stem loosening, nonunion and malunion. The Harris score was （35.26 ± 3.35 ） before the operation, which was improved to （84.70± 6.21 ） after the operation, and the good-to-ex- cellent rate was 80.77% （5 excellent cases, 16 good cases and 5 average cases）. X-ray showed that the prosthesis was stable, and the host bone and bone graft achieved bony union. Conclusion The prosthesis revision of the total hip arthroplasty with the greater trochanter reattachment device （GTR） and cortical strut bone graft used for the Vancouver type B3 periprosthetic proximal femur fractures has the advantages of simple manipulation, less complications, good recovery of the hip function and satisfactory results in the short period.