锁定钢板治疗全髋关节置换术后温哥华B1和C型股骨假体周围型骨折疗效分析

Vancouver type B1 and C Femoral Periprosthetic Fractures Following Total Hip Arthroplasty Treated by Locking- plate Osteosynthesis

目的：通过对骨折愈合率及再次手术的原因分析，评估锁定钢板治疗全髋关节置换术后温哥华 B1和C型股骨假体周围型骨折的疗效。方法：回顾2002年4月～2011年9月我科收治的采用锁定钢板治疗的全髋关节置换术后温哥华B 1和C型股骨假体周围型骨折患者45例。通过临床随访，分析手术6个月后骨折的愈合情况。结果：平均随访时间23个月，共6例患者再次手术，其中感染3例，内固定失败3例。结论：锁定钢板治疗全髋关节置换术后温哥华B1和C 型股骨假体周围型骨折疗效显著。感染是治疗失败的主要原因。锁定钢板能否跨越股骨柄的有效应力区域，是治疗的关键因素之一。

Objective：To assess rates of fracture union and analyze reoperative reasons , we evaluated the outcome of Vancouver typeB1 and C periprosthetic femoral fracture （PFFs ） treated by locking -plate osteosynthesis.Methods：45 patients with low -energy PFFVancouver type B1 and C fracture, underwent osteosynthesis with a locking plate from April 2002 through September 2011.All patientshad a total hip replacement （THR）.They were followed up clinically and radiographically , until fracture union or until death.Fracture unionwas evaluated 6 months post -operatively.Resul t：At a median follow -up time of 23months ,6 patients had been reoperated, infection（n=3 ）, failure of fixation（ n =3）.Conclusion：Locking- plate osteosynthesis of Vancouver type B1 and C PFFs gives good resultsfor fracture union.Infection is the major cause of failure.It appears that spanning of the prosthesis to avoid stress -rising areas is importantfor successful treatment.