人工髋关节置换术后Vancouver B型假体周围骨折的手术治疗

Surgical treatment of Vancouver B-type periprosthetic femoral fractures after artificial hip joint replacement

目的回顾性分析人工髋关节置换患者术后Vancouver B型股骨头周围骨折的手术治疗效果。方法2012年1月—2017年12月期间,中国石油天然气集团公司中心医院骨科共收治人工髋关节置换术后Vancouver B型股骨假体周围骨折患者27例,其中B1型骨折12例,B2型骨折14例,B3型骨折1例。所有的的患者均采用手术治疗,手术方式有同种异体皮质骨板加强固定(B1型骨折)、长柄全涂层假体翻修(B2型骨折)、长柄生物型假体及组配型假体(B3型骨折)等。术后对患者进行随访,通过X片和Harris评分等方式评估术后效果。结果所有病例均获得随访,平均随访时间4.5(1-5.5)年,髋关节功能得到了较好的恢复。骨折愈合良好,平均时间为5.3个月,术后Harris评分达83.7分,关节活动良好。术后出现并发症3例:1例术后出现假体松动,再次行手术治疗;1例发生关节周围感染;1例术后6个月出现移植骨排异反应。结论对于人工髋关节置换患者术后VancouverB型股骨头周围骨折的患者,同种异体皮质骨板加强固定、长柄全涂层假体翻修、长柄生物型假体及组配型假体等手术方式可以取得良好的手术治疗效果。

Objective To analyze the effects of surgical treatment of Vancouver B-type periprosthetic femoral fractures after artificial hip joint replacement.Methods 27 patients with Vancouver B-type periprosthetic femoral fracture after artificial hip joint replacement were treated with surgery:open reduction with steel wire binding or allograft cortical plate fixation for the Vancouver Bl-type(12 cases),removal of the original prosthetic and refurbishment using long-handled fully coated prostheses for the Vancouver B2-type(14 cases),or biological prosthesis or group type prosthesis and impaction bone grafting of allogeneic cancellous bone particles in medullary cavity combined with steel wire binding for the Vancouver B3-type(1 case).After operation,the patients were followed up regularly for 4.5(1~5.5)years and the imaging data were evaluated comprehensively with Harris score system.Results For all the patients,the function of hip joint recovered well,the fracture healed,and the alignment was good.The average healing time of the fracture was 5.3 months and the hip joint was in good motion.The average Harris score was 83.7.Postoperative complications occurred in 3 cases:one case of prosthesis stem loosening one year after surgery;one patient suffered from periarticular infection and repeated debridement,and one case had rejection of transplanted bone 6 months after operation.Conclusion Surgical methods of open reduction and fixation,a long revising stems,a long revising stem and bone allograft all achieve good surgical results in patients with Vancouver B-type periprosthetic femoral fractures after artificial hip joint replacement.