老年髋关节置换术后Vancouver B型股骨假体周围骨折的手术治疗

Surgical treatment of Vancouver B periprosthetic femur fracture after total hip arthrplasty

目的探讨老年髋关节置换术后Vancouver B型股骨假体周围骨折的手术治疗效果。方法我院于2010年7月至2014年5月,对髋关节置换术后Vancouver B型股骨假体周围骨折的50例患者,采用了AO钢板内固定联合钢丝捆扎,必要时进行加长股骨柄假体返修。术后对患者的髋关节Harris评分、双侧下肢长度和髋关节活动度进行评价。结果随访时间6~28月,平均（12.6±8.43）月。所有患者的骨折愈合良好,无不愈合、再次骨折及内固定断裂等情况发生。患侧髋关节Harris评分术前平均（33.21±8.24）分,术后1周平均（69.75±9.42）分,术后6月平均为（85.24±7.25）分,三者差异均有统计学意义（P〈0.05）。术前患肢短缩（1.7±0.8）cm,术后6月短缩（0.6±0.5）cm,治疗前后比较具有统计学差异（P〈0.05）。术后6月髋关节活动度得到明显改善,包括屈曲、外展、内收、外旋及内旋角度均比术前得到改善（P〈0.05）。结论髋关节置换术后Vancouver B型股骨假体周围骨折,钢丝捆扎结合钢板固定的手术治疗能取得满意的疗效。

Objective To investigate the effect of surgical treatment for Vancouver B periprosthetic femur fracture after hip arthroplasty. Methods In the study,50 patients with Vancouver B periprosthetic femoral fractures from July2010 to May 2014 were treated by AO plate fixation,steel strapping and lengthened femoral prosthesis. The effects were evaluated by Harris hip score,bilateral leg length and hip joint activity. Results All the patients were followed up for 6to 28 months（ 12. 6 ± 8. 43 months）. All fractures were healed well. The Harris hip score was 33. 21 ± 8. 24 before operation,being 69. 75 ± 9. 42,85. 24 ± 7. 25 one week or six months after operation with significant differences（ P〈0. 05）. The shortening length of preoperative limb was 1. 7 ± 0. 8 cm,compared to 0. 6 ± 0. 5 cm six months after operation（ P〈0. 05）. The range of motion of hip joint were significantly improved after 6 months＇ follow-up（ P〈0. 05）.Conclusions Steel strapping combined with plate fixation for Vancouver B-type periprosthetic femur fracture after hip arthroplasty could achieve satisfactory results.