锁定钢板联合钢缆内固定治疗Vancouver B1型股骨假体周围骨折的临床疗效评价

The clinical efficacy of locking plate combined with steel cable internal fixation for Vancouver type B1 periprosthetic femoral fracture

目的评价带线缆孔及大转子结合装置的锁定钢板治疗Vancouver B1型股骨假体周围骨折的临床疗效。方法2016年1月~2021年9月我院因Vancouver B1型股骨假体周围骨折行锁定钢板联合钢缆环扎内固定治疗的病人27例(27髋)。记录病人手术时间、术中出血量、住院时间、完全负重时间、髋关节Harris功能评分以及VAS疼痛评分。通过数字化X线摄片对假体、内固定钢板稳定性及骨折愈合情况进行评估。结果27例病人均获得随访,随访时间12~58个月,平均(21.74±15.42)个月,所有病人均获得骨折愈合,未发生感染、脱位、松动及骨折不愈合、畸形愈合等,术前平均HHS功能评分和VAS疼痛评分分别为为(31.84±3.92)分、(7.63±0.97)分,术后末次随访时分别为(85.43±4.73)分、(2.00±0.78)分,经锁定钢板联合钢缆环扎内固定治疗后,HHS评分和VAS疼痛评分的临床结局均较前明显好转,差异有统计学意义(P<0.05)。结论用带线缆孔及大转子结合装置的锁定钢板对Vancouver B1型股骨假体周围骨折治疗可以取得满意的临床疗效。

Objective To evaluate the clinical efficacy of locking plate with cable hole and greater trochanteric union device in the treatment of Vancouver type B1 periprosthetic femoral fractures.Methods A retrospective analysis of the clinical data of 27 patients(27 hips)who underwent internal fixation with locking plates combined with cable loops for periprosthetic femoral fracture in Renmin Hospital of Wuhan University from January 2016 to September 2021.The surgery time,intraoperative bleeding volume,hospitalization days,complete weight bearing time,Harris hip functional score,and VAS pain score were recorded.Prosthesis and internal fixation plate stability and fracture healing were assessed by digital radiographs.Results All 27 patients were followed up for 12-58 months,with a mean of(21.74±15.42)months.All patients achieved fracture healing without infection,dislocation,loosening,non-union or malunion,and the mean preoperative HHS functional score and VAS pain score were(31.84±3.92)and(7.63±0.97)points.The mean HHS and VAS pain scores at the final postoperative follow-up were(85.43±4.73)and(2.00±0.78),and the clinical outcomes of HHS scores and VAS pain scores were significantly better after treatment with locking plates combined with cable ring internal fixation,with statistically significant differences(P<0.05).ConclusionThe treatment of periprosthetic femoral fractures of Vancouver B1 type with a locking plate with a cable hole and a greater trochanteric union device can achieve satisfactory clinical outcomes.