Dynamic compression plates for Vancouver type B periprosthetic femoral fractures: a 3-year follow-up of 18 cases

Background There is no consensus on the best surgical treatment of periprosthetic femoral fractures. We report our experience with a dynamic compression plate.

Patients and methods We reviewed the results of 18 periprosthetic femoral fractures treated with open reduction and internal fixation using the dynamic compression plate (DCP). There were 7 Vancouver type B1, 2 type B2 and 9 type B3 fractures. 16 cases had previously undergone at least one revision procedure. In addition to a DCP plate, all B2 and B3 fractures were revised to cemented prostheses, and all B3 fractures were revised with impaction grafting. Mean follow-up was 39 months.

Results The mean healing time for those 11 cases that united was 13 months. One B1-type and one B3-type fracture with plate fracture within 8 months of surgery failed to heal. Furthermore, one B1-type fracture and one B2-type fracture failed and developed nonunion. 3 patients died, from causes not related to surgery, within 8 months after surgery without signs of healing.

Interpretation Open reduction and internal fixation using DCPs seems to be a valid method for the treatment of postoperative periprosthetic femoral fractures with stable stem in place. If the stem is unstable, we suggest that DCPs may be used in association with femoral revision using a long stem. In cases with stable stem (B1), we are inclined to agree with other authors that additional fixation using an extramedullary cortical strut graft may be necessary to improve stability and promote final healing.     

Dynamic compression plates for Vancouver type B periprosthetic femoral fractures

Background There is no consensus on the best surgical treatment of periprosthetic femoral fractures. We report our experience with a dynamic compression plate.

Patients and methods We reviewed the results of 18 periprosthetic femoral fractures treated with open reduction and internal fixation using the dynamic compression plate (DCP). There were 7 Vancouver type B1, 2 type B2 and 9 type B3 fractures. 16 cases had previously undergone at least one revision procedure. In addition to a DCP plate, all B2 and B3 fractures were revised to cemented prostheses, and all B3 fractures were revised with impaction grafting. Mean follow-up was 39 months.

Results The mean healing time for those 11 cases that united was 13 months. One B1-type and one B3-type fracture with plate fracture within 8 months of surgery failed to heal. Furthermore, one B1-type fracture and one B2-type fracture failed and developed nonunion. 3 patients died, from causes not related to surgery, within 8 months after surgery without signs of healing.

Interpretation Open reduction and internal fixation using DCPs seems to be a valid method for the treatment of postoperative periprosthetic femoral fractures with stable stem in place. If the stem is unstable, we suggest that DCPs may be used in association with femoral revision using a long stem. In cases with stable stem (B1), we are inclined to agree with other authors that additional fixation using an extramedullary cortical strut graft may be necessary to improve stability and promote final healing.     

Increased risk of intraoperative and early postoperative periprosthetic femoral fracture with uncemented stems

Background and purpose — The use of uncemented fixation in total hip arthroplasty (THA) is increasing. Registry studies have indicated an increased risk of revision of uncemented implants due to early periprosthetic femoral fracture. In this paper, we describe the incidence and predisposing factors for intraoperative and early postoperative (≤ 90 days) periprosthetic femoral fractures after cemented and uncemented THA.

Patients and methods — This was a prospective observational study in 8 Danish high-volume centers from February 2010 to November 2013. We used the 90-day follow-up from the Danish National Patient Registry and patient records. We obtained intraoperative information from the Danish Hip Arthroplasty Registry and from surgical notes.

Results — Of 7,169 primary consecutive THAs, 5,482 (77%) were performed using uncemented femoral components. The total incidence of periprosthetic femoral fractures ≤ 90 days postoperatively was 2.1% (n = 150). 70 fractures were detected intraoperatively (46 required osteosynthesis). 51 postoperatively detected fractures occurred without trauma (42 of which were reoperated) and 29 were postoperative fall-related fractures (27 of which were reoperated). 134 fractures (2.4%) were found in uncemented femoral components and 16 (0.9%) were found in cemented femoral components (p < 0.001). Uncemented femoral stem (relative risk (RR)?=?4.1, 95% CI: 2.3–7.2), medically treated osteoporosis (RR =2.8, CI: 1.6–4.8), female sex (RR =1.6, CI: 1.1–2.2), and age (RR =1.4 per 10 years, CI: 1.2–1.6) were associated with increased risk of periprosthetic femoral fracture when analyzed using multivariable regression analysis.

Interpretation — Uncemented femoral components were associated with an increased risk of early periprosthetic femoral fractures, especially in elderly, female, and osteoporotic patients.     

Impaction bone grafting for periprosthetic fractures around a total hip arthroplasty

The incidence of periprosthetic fractures has been reported to be between 1 and 20.9% and appears to be on the rise. Fractures that occur around the femoral stem, particularly when the stem is loose or there is a loss of bone stock pose a technical challenge. These are rare injuries and there is considerable debate regarding their optimal treatment. Reconstruction with large segment endoprosthetic replacement is an acceptable solution for elderly patients who have limited functional demands and where the prosthesis is expected to outlive the patient. The younger patient poses a much greater challenge, the bone must be reconstituted and the femoral canal geometry must sufficiently restored to allow the stable insertion of a prosthesis. There are very few techniques that exist in this scenario. One such technique is impaction bone grafting and revision to a long smooth tapered cemented stem. This allows the restoration of bone stock and the stable insertion of a prosthesis. The aim of this article is to discuss the theory behind impaction bone grafting, the technical aspects and challenges of this technique, including fracture reduction methods, and to appraise all the literature available on impaction bone grafting for periprosthetic fractures.     

Cancellous impaction grafting in femoral revision THA

Options in the management of the deficient femur during revision hip arthroplasty include cemented or cementless fixation. The results with cemented femoral revision have not been historically successful. While the use of extensively coated implants in revision total hip arthroplasty has been more uniformly excellent, issues, such as thigh pain, stress shielding, and lack of bone stock restoration, have been raised. Impaction grafting in revision hip arthroplasty is an attempt to reconstitute bone stock and avoid problems associated with excessively large or long uncemented stems. The original concept of impaction grafting was promoted by Slooff and applied to the femur by Gie and Ling. While originators' results were promising, issues, such as fracture and poor graft delivery, were noted. Modifications to the original technique were recently described by Howie, which used longer stems when necessary, as well as an improved graft delivery system. We report our results with 30 consecutive hips using this method. At follow-up, 3 patients were known to have died, leaving 27 for evaluation. Two of the 27 were failures: 1 recurrence of infection and 1 loose stem. The remaining 25 were clinical successes with bone stock restoration in all and no periprosthetic fractures. We believe that impaction grafting remains a viable option for the management of the severely deficient femur in whom cementless fixation methods are questionable.     

Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision

BACKGROUND: Revision total hip arthroplasty is indicated for most periprosthetic fractures that occur around the stem of the femoral implant. The purpose of the present study was to assess the results and complications of revision total hip arthroplasty for the treatment of periprosthetic femoral fractures. METHODS: We evaluated 118 hips in 116 patients who underwent revision total hip arthroplasty because of an acute Vancouver type-B periprosthetic femoral fracture. The femoral implant used for the revision was a cemented stem in forty-two hips, a proximally porous-coated uncemented stem in twenty-eight, an extensively porous-coated stem in thirty, and an allograft-prosthesis composite or tumor prosthesis in eighteen. The mean duration of follow-up was 5.4 years. RESULTS: Kaplan-Meier analysis demonstrated that the probability of survival was 90% at five years and 79.2% at ten years with revision or removal of the femoral implant for any reason as the end point. Sixteen femoral components were rerevised: ten were rerevised because of loosening; three, because of loosening in association with a fracture nonunion; two, because of recurrent dislocation; and one, because of a new periprosthetic fracture. Additionally, six femoral implants were resected because of deep infection (five) or prosthetic loosening (one). Radiographs of the ninety-six hips with a surviving implant showed that twenty-one had evidence of loosening of the femoral implant, four had a nonunion of the femoral fracture, and two had both a nonunion and loosening of the femoral implant. CONCLUSIONS: Revision total hip arthroplasty for the treatment of a periprosthetic fracture around the stem of the femoral implant successfully restored function for most patients. The greatest long-term problems were prosthetic loosening and fracture nonunion. Better results were seen when an uncemented, extensively porous-coated stem was used.     

髋关节置换术中股骨假体周围骨折危险因素的分析

目的分析髋关节置换术中股骨假体周围骨折的发生情况和危险因素。方法选择本组自2002年1月至2008年12月所有行初次和翻修髋关节置换术患者共3021髋(初次置换术2718髋,翻修术294髋),分析术中股骨假体周围骨折的发生情况,并用Logistic回归分析骨折发生的相关因素,包括性别、年龄、术前诊断、假体类型、固定方式。用2检验进行初次置换和翻修术中发生骨折的差异性检验。结果总的术中股骨假体周围骨折发生率为5.7%(173/3021),其中初次置换发生率为4.0%(110/2718),翻修术发生率为21.4%(63/294)。初次置换应用骨水泥股骨假体术中骨折发生率为1.9%(8/429),非骨水泥股骨假体术中骨折发生率为4.5%(102/2289),初次置换术中骨折82.7%(91/110)发生于干骺端;翻修术应用骨水泥股骨假体术中骨折发生率为18.8%(21/112),非骨水泥股骨假体术中骨折发生率为23.1%(42/182),翻修术术中骨折62%(39/63)发生于骨干部。Logistic回归分析显示:初次髋关节置换术中骨折的危险因素包括性别、术前诊断、固定方式、假体类型;翻修术性别、年龄、假体固定方式不是引起术中骨折的危险因素。应用2检验,翻修术中股骨假体骨折的风险与初次置换相比差异有统计学意义(P0.000),OR值为6.5,95%CI(4.6,9.1)。结论初次髋关节置换术中股骨假体周围骨折的发生率为4.0%,主要发生于干骺端(83.6%),女性、髋关节发育不良、髋部骨折、高位脱位、非骨水泥固定是术中骨折的危险因素;髋关节翻修术中股骨假体周围骨折的发生率(21.4%),远高于初次髋关节置换术,主要发生于骨干部(61.9%),骨折的发生与否可能主要取决于翻修时的骨质情况,性别、年龄、假体固定方式并不是主要的影响因素。     

Grafting for periprosthetic femoral fractures: strut, impaction or femoral replacement

Peri-prosthetic fractures are technically demanding to treat, as they require the skills of revision arthroplasty as well as those of trauma surgery. [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857-65.] reporting on 1049 periprosthetic femoral fractures found that the annual incidence varied between 0.045% and 0.13% for all THAs performed in Sweden and that the accumulated incidence for the primary hip arthroplasties was 0.4% while for the revision arthroplasties was 2.1% [Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic femoral fractures classification and demographics of 1049 periprosthetic femoral fractures from the Swedish National Hip Arthroplasty Register. J Arthroplasty 2005;20:857-65.]. The elderly population is particularly vulnerable to low energy periprosthetic fractures attributed to osteopenia or osteoporosis leaving limited reconstruction options to the hip revision surgeon. Bone grafting in the form of autograft has well recognized limitations and allograft represents the gold standard of bone augmentation in the majority of the cases. Allograft can be used as morselised in the form of impaction grafting, reconstructing the bone from within out, or in the form of structural allograft. In the latter case, strut onlay plates or whole proximal femoral allografts can be used to augment the deficient bone or to totally replace it respectively. Immune reaction and disease transmission along with delayed revascularization of the cortical allograft can cause failure of the construct in the long term; however, the results to date from their use are promising. We here present an overview of the literature on the use of available bone grafts in the treatment of periprosthetic femoral fractures.     

Impaction allografting revision for B3 periprosthetic femoral fractures using a Mennen plate to contain the graft: a technical report

We prospectively evaluated the long-term results of a technique using the Mennen plate to contain impacted allograft and support cemented Exeter stem revision fixation for the treatment of three B3 periprosthetic femoral fractures (PFFs). Three patients with a median age of 77 years were followed-up for a median of 84 months. In all cases the stem bypassed the distal fracture line by a median length of 85 mm (median ratio over femoral diameter = 2.13). The median postoperative Charnley-Merle d'Aubigné-Postel score for pain, function and range of movement was 5, 3 and 6 respectively. Impaction allografting revision could be used for B3 PFFs when the stem bypasses the most distal fracture line by at least two ipsilateral femoral diameters. The Mennen plate can aid to contain the impacted allograft and to maintain fracture reduction and short term stability thereafter, but the long stem is necessary for long-term stability and healing.     

Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty: A 3-year follow-up of 23 cases

Background and purpose Revision surgery for periprosthetic femoral fractures around an unstable cemented femoral stem traditionally requires removal of existing cement. We propose a new technique whereby a well-fixed cement mantle can be retained in cases with simple fractures that can be reduced anatomically when a cemented revision is planned. This technique is well established in femoral stem revision, but not in association with a fracture.Patients and methods We treated 23 Vancouver type B periprosthetic femoral fractures by reducing the fracture and cementing a revision stem into the pre-existing cement mantle, with or without supplementary fixation.Results 3 patients died in the first 6 months for reasons unrelated to surgery. In addition, 1 was too frail to attend follow-up and was therefore excluded from the study, and 1 patient underwent revision surgery for a nonunion. The remaining 18 cases all healed with radiographic union after an average time of 4.4 (2–11) months. There was no sign of loosening or subsidence of the revision stems within the old cement mantle in any of these cases at the most recent follow-up after an average of 3 (0.3–9) years.Interpretation Our results support the use of the cement-in-cement revision in anatomically reducible periprosthetic fractures with a well-preserved pre-existing cement mantle. This technique is particularly useful for the elderly patient and for those who are not fit for prolonged surgical procedures.     

Periprosthetic femoral fractures treated with a modular distally cemented stem

PURPOSE: To assess the treatment outcome of revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures using a modular distally cemented stem. METHODS: 22 men and 14 women (37 hips) aged 66 to 79 (mean, 70) years underwent revision hip arthroplasty for Vancouver type B3 periprosthetic femoral fractures. The indication for surgery was periprosthetic fracture with stem loosening and loss of proximal bone stock. The patients were referred from other hospitals after previous surgeries had failed: 8 with 3 previous surgeries, 19 with 2, and 9 with one. Using a transtrochanteric approach, the existing prosthesis was removed and a modular proximal femoral replacement stem was inserted, bypassing the area of proximal femoral fracture and bone loss. The stem was distally cemented. Patients were immobilised within 48 hours of surgery. RESULTS: Patients were followed up for a mean of 14 (range, 8-18) years. The mean Harris hip score improved from 29 (range, 5-40) to 78 (range, 56-88); 24 patients attained excellent or good scores (>80), 10 attained fair, and 2 attained poor scores. The mean healing time was 7 (range, 6-14) months; there was no non-union. Improvement in proximal bone stock was noted on serial radiographs. None of the stems had cement fracture or migration, requiring revision. Two (5%) of the patients had dislocations. CONCLUSION: Vancouver type B3 periprosthetic femoral fractures can be successfully treated with a distally cemented modular proximal femoral replacement prosthesis.     

Intramedullary strut substitution and impaction allografting cemented revision for the treatment of a periprosthetic fracture in a severely compromised femur

Revision for the treatment of a B3 periprosthetic femoral fracture often requires proximal femoral allograft arthroplasty in physiologically young or tumor prostheses in elderly patients. Extramedullary strut allograft augmentation can only be used when the host femur is structurally adequate for the insertion of the revision stem (periprosthetic femoral fractures type B2) and appears to be an attractive biological concept as early incorporation to the host bone results in a sound biomechanical construct. We report here the simultaneous use of whole femur intramedullary strut substitution along with an extramedullary strut graft placement, with impaction allografting revision to a long cemented femoral prosthesis, to augment the deficient metadiaphyseal bone stock (Paprosky type IV) for the treatment of a complex type B3 periprosthetic femoral fracture.     

Failure rates for 4762 revision total hip arthroplasties in the Norwegian Arthroplasty Register

We present the results for 4762 revision total hip arthroplasties with no previous infection in the hip, which were reported to the Norwegian Arthroplasty Register between 1987 and 2003. The ten-year failure rate for revised prostheses was 26% (95% CI 25 to 26). Cox regression analyses were undertaken separately for acetabular and femoral revision components. Cemented revision components without allograft was the reference category. For acetabular components, we found a significantly reduced risk of failure for uncemented revisions both with (relative risk (RR) = 0.66; 95% CI 0.43 to 0.99) and without (RR = 0.37; 95% CI 0.22 to 0.61) allograft. For femoral components, we found a significantly reduced risk of failure for uncemented revisions, both with (RR = 0.27; 95% CI 0.16 to 0.46) and without (RR = 0.22; 95% CI 0.11 to 0.46) unimpacted allograft. This reduced risk of failure also applied to cemented revision components with allograft (RR = 0.53; 95% CI 0.33 to 0.84) and with impaction bone grafting (RR = 0.34; 95% CI 0.19 to 0.62). Revision prostheses have generally inferior results when compared with primary prostheses. Recementation without allograft, and uncemented revision with bone impaction, were associated with worse results than the other revision techniques which we studied.     

全髋关节置换术后股骨假体周围骨折的治疗

目的：分析全髋关节置换术后股骨假体周围骨折的病因和治疗结果．探讨其治疗方法。方法：回顾性研究自1998年12月-2003年3月治疗并随访观察的11例全髋关节置换术后股骨假体周围骨折患者，男8例，女3例，平均年龄为56岁(43-75岁)，采用Vancouver分型，A型2例，B2型7例．B3型1例，C型1例。采用非手术治疗5例；手术治疗6例，其中1例为非手术治疗后骨折畸形愈合行翻修术。采用长柄假体翻修联合异体皮质骨板固定5例．其中使用非骨水泥型远端固定假体4例．使用骨水泥型假体1例。采用切开复位内固定治疗1例。结果：所有病例均获随访，平均随访25．6个月(7～50个月)。9例骨折愈合，平均愈合时间4个月(3-6个月)，2例骨折未愈合。均为非手术治疗病例，手术治疗6例骨折均愈合。至目前为止，7例假体稳定，1例翻修术后出现连续的影像学透亮线．3例假体松动，假体稳定的患者功能好于假体松动者．假体稳定患者的Harris评分平均91分。所有异体皮质骨板在1年内均与宿主骨整台．没有异体皮质骨板骨折发生。结论：假体稳定的A型骨折可以采用非手术治疗。对于B1型和C型骨折，如无手术禁忌证，应行切开复位内固定术。对于假体松动的骨折患者，使用长柄远端固定非骨水混型假体联合异体皮质骨板是最佳的治疗方法。     

Revision total hip arthroplasty: the femoral side using cemented implants

Advances in surgical technique and implant technology have improved the ten-year survival after primary total hip arthroplasty (THA). Despite this, the number of revision procedures has been increasing in recent years, a trend which is predicted to continue into the future. Revision THA is a technically demanding procedure often complicated by a loss of host bone stock which may be compounded by the need to remove primary implants. Both cemented and uncemented implant designs are commonly used in the United Kingdom for primary and revision THA and much controversy still exists as to the ideal method of stem fixation. In this article we discuss revision of the femur using cemented components during revision THA. We focus on three clinical scenarios including femoral cement-in-cement revision where the primary femoral cement-bone interface remains well fixed, femoral cement-in-cement revision for peri-prosthetic femoral fractures, and femoral impaction grafting. We discuss the clinical indications, surgical techniques and clinical outcomes for each of these procedures.     

Favorable mid-to-long-term results of impaction bone grafting using a fresh frozen allograft bone with cemented stem for the treatment of Paprosky IV femoral bone defects

BackgroundFemoral revision surgery in patients with substantial bone loss is challenging. Impaction bone grafting using a cemented stem can be a good solution for reconstruction of the femur with poor bone stock and extensive bone loss. This study aimed to evaluate the mid-to-long-term clinical and radiographic results of impaction bone grafting using a cemented stem for Paprosky IV femoral bone defects.MethodsThirteen patients (13 hips) who underwent revision total hip arthroplasty with impaction bone grafting using a cemented stem and were followed up for at least 5 years were enrolled in this study. In all patients, a sufficient amount of fresh frozen bone of good quality was used. When cortical segmental defects were present, peripheral reinforcement with metal mesh and strut allograft was performed. The average follow-up duration was 11.1 (range, 5.3–15.1) years. The clinical and radiographic outcomes were reviewed at the final follow-up.ResultsThe average Harris hip score was 82.5 (range, 79–94), and the average University of California, Los Angeles activity score was 5.6 (range, 4–8) at the final follow-up. Radiographic assessment revealed an average femoral component subsidence level of 0.67 (range, 0.05–2.81) mm. There were no complications, except one case (7.6%) of periprosthetic fracture.ConclusionsImpaction bone grafting using a cemented stem yielded excellent mid-to-long-term outcomes. It is a reliable technique for Paprosky IV femoral bone defects, and even when severe femoral cortical bone defects are present, long-term stability can be obtained using a metal mesh and/or strut allograft.     

Temporary total hip arthroplasty-like spacer for treating an infected periprosthetic femoral fracture using a long stem: A case report

IntroductionInfected periprosthetic femoral fractures are among the most complex and significant complications of total hip arthroplasty (THA). We report the novel use of a temporary THA-like spacer for treating an infected periprosthetic femoral fracture after revision surgery using a long stem.Case presentationWe present a 72-year-old woman sustained a left infected periprosthetic femoral fracture after revi - streptococci in the culture sample. On suspicion of a periprosthetic joint infection, we planned a two-stage procedure. We used a temporary THA-like spacer comprising the removed femoral long stem, which was autoclaved and then reimplanted, and applied a new polyethylene acetabular liner. Both components were cemented in place with antibioticloaded bone cement, without applying strong pressure. Pain control waseasily achieved postoperatively because the fracture had been stabilized early. The THA-like spacer was stable, and allowed a good range of motion without pain. She was allowed to move with a wheelchair and was walk with partial weight bearing without pain. Seven week after the initial THAlike spacer placement, we performed a revision THA after successful control of infection. At the 1-year follow-up, the patient remained free of infection.ConclusionsTemporary antibiotic-loaded cement-coated THA-like spacer using a long stem facilitated the eradication of infection, fracture stabilization, and enables partial weight bearing without pain.     

Intraoperative periprosthetic hip fractures

Periprosthetic femoral fractures are among the most difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and the increased indications of primary and revision hip arthroplasty has led to an escalating incidence. Intraoperative periprosthetic fractures are becoming more common given the increased numbers of revision total hip arthroplasty and the use of cementless fixation. Risk factors for intraoperative periprosthetic fractures include the use of minimally invasive techniques; the use of press-fit cementless stems and cups; revision surgery, specially when a long cementless stem or a short stem with impaction allografting is used; female gender; metabolic bone disease; bone diseases leading to altered morphology such as Paget disease and technical errors during the operation.     

The extent of the bone defect affects the outcome of femoral reconstruction in revision surgery with impacted bone grafting: a five- to 17-year follow-up study

We report the results of 79 patients (81 hips) who underwent impaction grafting at revision hip replacement using the Exeter femoral stem. Their mean age was 64 years (31 to 83). According to the Endoklinik classification, 20 hips had a type 2 bone defect, 40 had type 3, and 21 had type 4. The mean follow-up for unrevised stems was 10.4 years (5 to 17). There were 12 re-operations due to intra- and post-operative fractures, infection (one hip) and aseptic loosening (one hip). All re-operations affected type 3 (6 hips) and 4 (6 hips) bone defects. The survival rate for re-operation for any cause was 100% for type 2, 81.2% (95% confidence interval (CI) 67.1 to 95.3) for type 3, and 70.8% (95% CI 51.1 to 90.5) for type 4 defects at 14 years. The survival rate with further revision for aseptic loosening as the end point was 98.6% (95% CI 95.8 to 100). The final clinical score was higher for patients with type 2 bone defects than type 4 regarding pain, function and range of movement. Limp was most frequent in the type 4 group (p < 0.001). The mean subsidence of the stem was 2.3 mm (SD 3.7) for hips with a type 2 defect, 4.3 mm (SD 7.2) for type 3 and 9.6 mm (SD 10.8) for type 4 (p = 0.022). The impacted bone grafting technique has good clinical results in femoral revision. However, major bone defects affect clinical outcome and also result in more operative complications.     

Solution广泛多孔钛涂层长柄假体结合钢丝环扎固定治疗股骨头置换术后Vancouver B2型假体周围骨折的中期随访

背景：股骨头置换术后Vancouver B2型假体周围骨折多伴有假体松动,患者年龄大,并存疾病多,骨质条件差,围手术期处理及手术技术难度大,并发症发生率高。 目的：评价Solution广泛多孔钛涂层长柄假体结合钢丝环扎固定治疗股骨头置换术后Vancouver B2型假体周围骨折的中期疗效。 方法：回顾分析2008年1月至2010年12月我科收治的14例股骨头置换术后Vancouver B2型假体周围骨折患者的临床资料,其中男6例,女8例,年龄66-80岁,平均70.3岁。所有患者均采用骨折切开复位钢丝环扎固定结合Solution股骨柄进行翻修手术。末次随访时进行Harris髋关节评分（术前由于骨折未能进行Harris髋关节评分）;术前,术后3、6、12个月及末次随访时摄X线片,用于评价骨折复位及愈合,假体初始固定及中期生存情况。 结果：共16例患者,1例术后3年死于肺癌,1例失访,14例获得随访,随访时间3-5年,平均4.2年。末次随访时Harris评分88.7分。X线显示骨折复位,股骨柄超过骨折远端的固定长度超过5 cm,与股骨压配良好。骨折愈合时间3-6个月,平均（3.8＆#177;1.3）个月。末次随访时未见股骨柄松动、下沉。无感染、深静脉血栓形成和肺栓塞。 结论：Solution股骨柄结合钢丝环扎固定治疗股骨头置换术后Vancouver B2型假体周围骨折中期疗效好,其远期结果有待于进一步的随访。