全涂层远端固定长柄假体治疗髋关节置换术后股骨假体周围骨折的临床研究

目的分析全涂层远端固定长柄假体治疗髋关节置换术后假体周围骨折的临床效果。方法回顾性分析35例使用全涂层远端固定长柄假体治疗的髋关节置换术后股骨假体周围骨折病例，根据Vancouver分型，B2型12例，B3型20例，C型3例，通过Harris评分对患髋进行功能评价，X线片观察骨折愈合、股骨柄下沉情况。结果3例行单纯长柄假体翻修，10例行长柄假体翻修＋钢丝环扎固定，22例行长柄假体翻修＋同种异体颗粒骨压配植骨＋同种异体骨板捆绑固定治疗，平均随访4．5年，所有骨折均顺利愈合，平均愈合时间为15．3周，Harris评分平均86．5分，2例股骨柄分别下沉3mm和4mm，均在术后3个月达到稳定，32例假体获得骨长入固定，3例获得稳定的纤维固定，未发现骨溶解、感染以及再发骨折。结论髋关节置换术后假体周围骨折选择全涂层远端固定长柄假体翻修，根据骨缺损严重程度合理选择同种异体颗粒骨打压植骨＋同种异体骨板捆绑固定可以获得良好的临床效果。

Extensively porous -coated distal fixation long stem prosthesis for periprosthetic fracture after hip replacement

Objective To summarize the clinic outcomes of periprosthetic fracture after hip replacement treated by extensively porous-coated distal fixation long stem implant. Methods 35 patients with periprosthetic fracture （including 12 of Vancouver Type B2, 20 of Type B3 and three of Type C） after hip replacement were treated by extensively porous-coated distal fixation long stem implant and followed up for at least 12 months. The results were assessed by Harris score and radiographic images were taken to observe the healing status. Results The mean follow-up duration was 4.5 years; all fractures healed with a mean time of 15.3 weeks; the mean Harris score was 86.5. There was bony ingrowth fixation in 32 cases and stable fibrous fixation in three cases. Subsidence was noticed in two cases during the first month, then the stems had satisfactory fixation without further subsidence. No osteolysis, infection or re-fracture were observed. Conclusion Revision using all-coated distal fixation long stem prosthesis leads to reproducibly good results in the treatment of periprosthetic hip fractures.