髋关节置换术后Vancouver B型股骨假体周围骨折手术方法选择与治疗要点  

Choice of operative methods and main points of treatment for Vancouver type B periprosthetic femoral fractures after hip arthroplasty

作　　者：任俊涛[1] 张云飞[1] 李鹏[1] 王翔宇[1] 马凯 REN Jun-tao;ZHANG Yu-fei;LI Peng;WANG Xiang-yu;MA Kai(Department of Orthopedics,Xiangyang Hospital Affiliated to Hubei University of Traditional Chinese Medicine,Xiangyang Institute of Traditional Chinese Medicine,Xiangyang,Hubei 441000,China)

机构地区：[1]湖北中医药大学附属襄阳医院,襄阳市中医医院(襄阳市中医药研究所)骨科,湖北441000

出　　处：《中国骨与关节损伤杂志》2020年第10期1024-1027,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨人工髋关节置换术后Vancouver B型股骨假体周围骨折的手术方法与治疗体会。方法回顾性分析自2015-08—2019-02诊治的12例Vancouver B型股骨假体周围骨折。5例Vancouver B1型骨折采用锁定钢板联合近端钢丝单皮质螺钉、远端双皮质螺钉固定,同时进行植骨。1例Vancouver B1型骨折在术中发现股骨假体松动,采用加长型骨水泥型股骨柄翻修,钢丝环扎固定,同时进行植骨。5例Vancouver B2型骨折采用非骨水泥型股骨假体翻修,钢丝环扎固定骨折,同时进行植骨。1例Vancouver B3型骨折采用生物型长柄股骨假体翻修,钢丝环扎固定,股骨外骨板联合髓内骨粒打压植骨。结果12例均获得随访,随访时间平均16(8~36)个月。骨折愈合时间3~8个月,平均4.6个月。末次随访时髋关节功能Harris评分79~84分,平均81分。随访期间无骨折不愈合、假体松动、感染等并发症。结论对于人工髋关节置换术后Vancouver B型股骨假体周围骨折,术者应根据骨折位置、假体有无松动、局部骨质、患者一般情况选择不同的手术治疗方法,手术治疗要点是骨折部分需坚强固定、假体松动需翻修、植骨促进骨折愈合。Objective To explore the choice of operative methods and the main points of treatment for Vancouver type B periprosthetic femoral fractures after hip arthroplasty.Methods A retrospective analysis of 12 cases of Vancouver type B periprosthetic femoral fractures after hip arthroplasty treated from August 2015 to February 2019 was performed.Five cases with type B1 underwent open reduction with locking plate and wires and allograft strut to fix the fractures.One case with type B1 was found femoral prosthesis loosening during the operation,open reduction and internal fixation with wires and allografl cortical strut bone and a longer stem cement prosthesis revision were performed.Five cases with type B2 undergone open reduction with a longer stem cementless prosthesis revision and wires and allograft strut fo fix the fracture.One case with type B3 undergone open reduction with a longer stem cementless prosthesis revision and wires and allograft strut to restore bone.Results Twelve patients were followed up from 8 months to 36 months(average 16 months),all patients’fracture healed within 3 months to 8 months(average 4.6 months)after surgery.The Harris Hip Score was 79 points to 84 points(average 81 points)at the time of the final follow-up.Postoperative patients had no complications,such as nonunion,stem loosening or infection.Conclusion Different treatment should be used according to sub-classification of Vancouver type B fractures,stem loosening,local bone situation,patient’s body situation.Main points of surgical treatment for bone fracture include strong fixation,revision for prosthesis loosening,bone graft for fracture healing.

关 键 词：人工髋关节置换术 Vancouver B型股骨假体周围骨折 翻修手术 钢丝环扎 植骨 

分 类 号：R687.3[医药卫生—骨科学]