生物型全涂层股骨长柄假体治疗Vancouver B2型股骨假体周围骨折  

Uncemented fully porous-coated long femoral stem prosthesis for management of Vancouver type B2 periprosthetic femoral fracture

作　　者：都斌[1] 王勇[1] 蒋建农[1] 张盘军[1] 焦杰君[1] 

机构地区：[1]江苏大学附属宜兴市人民医院骨科,214200

出　　处：《中华创伤杂志》2015年第8期709-713,共5页Chinese Journal of Trauma

摘　　要：目的探讨应用生物型全涂层股骨长柄假体治疗人工髋关节置换术后Vancouver B2型股骨假体周围骨折的临床疗效。方法回顾性分析2006年2月-2013年1月应用生物型全涂层股骨长柄假体行股骨侧翻修结合钢丝或钛缆捆扎固定治疗的Vancouver B2型股骨假体周围骨折患者12例，其中男5例，女7例；年龄62—79岁，平均69．8岁。半髋关节置换术后2例，初次全髋关节置换术后10例；初次置换股骨柄为骨水泥固定2例，生物型固定10例。末次随访时采用Harris评分行临床疗效评估，采用Beals和Tower标准行影像学评估，记录术中、术后并发症。结果术中无一例出现股骨穿孔、股骨骨折等并发症。所有患者均获随访平均38个月（24～72个月）。末次随访时Harris评分平均为87．2分（50—100分）。骨折均获得愈合，平均为16周（12～28周）；股骨柄假体均获得骨性稳定，1例出现下沉3mm；1例术后4个月行走时不慎摔倒致Vancouver B1型骨折，行锁定加压钢板结合钛缆捆扎固定。影像学评估按照Beals和Tower标准：优10例，良1例，差1例。随访期间无深静脉血栓、脱位、假体松动等并发症发生。结论生物型全涂层股骨长柄假体初始稳定性好，可为骨折愈合提供良好的髓内环境，有利于骨折愈合，是治疗Vancouver B2型股骨假体周围骨折的理想选择。Objective To evaluate the clinical results of uncemented fully porous-coated long femoral stems in treating Vancouver type B2 periprosthetic femoral fracture following hip arthroplasty. Methods A retrospective analysis was made on 12 patients （12 hips） with Vancouver type B2 periprosthetic femoral fracture treated using the uncemented fully porous-coated long femoral stem prosthesis combined with cerclage fixation with steal-wire or titanium cable devices from February 2006 to January 2013. There were 5 males and 7 females, aged average 69.8 years （range, 62 to 79 years）. The status of primary arthroplasty was uncemented bipolar hemiarthroplasty in 2 patients and total hip arthroplasty in 10 patients （2 cement and 8 eementless femoral stems）. At the final follow-up, Harris hip score for clinical evaluation, Beals and Tower＇s criteria for radiological evaluation, and complications were recorded. Results There were no intra-operative complications such as femoral perforation and femoral fracture. All patients were followed up for mean 38 months （range, 24-72 months ）. At the last follow- up, mean Harris hip score was 87.2 points （range, 50 to 100 points）. All fractures healed at average 16 weeks （range, 12-28 weeks）. All the 12 hips showed prosthesis stability despite there was one femoral stem subsidence of 3 mm. One patient slipped and sustained another periprosthetic fracture （Vancouver type B1 ） at postoperative 4 months and was treated successfully with locking plate and cables. According to the Beals and Tower＇s criteria, there were 10 excellent, 1 good and 1 poor results. Final follow-up revealed no complications of deep vein thrombosis, dislocation and prosthesis loosening. Conclusion Uncemented fully porous-coated long femoral stems provide good primary stability that promotes fracture healing and offers a reasonable treatment of Vancouver B2 femoral periprosthetic fracture.

关 键 词：股骨颈骨折 关节成形术 置换 髋 假体周围骨折 

分 类 号：R687.3[医药卫生—骨科学]