van der Wal B C H, Vischjager M, Grimm B, Heyligers I C, Tonino A J
Department of Orthopaedic Surgery, Atrium Medical Center, 6401 CX, Heerlen, The Netherlands.
Int Orthop. 2005 Aug;29(4):235-40. doi: 10.1007/s00264-005-0657-3. Epub 2005 Jun 1.
We studied 14 periprosthetic femoral fractures out of a series of 619 hydroxyapatite coated hip implants and compared the outcome to published treatment algorithms using the Vancouver classification. There were five type A fractures, six B1, two B2, and one type B3 fracture. All but one type A fractures were treated conservatively. Compared with the Vancouver classification, we observed a different fracture type in the type B fractures. No fractures at the tip of the stem were seen, as in cemented implants. Three B1 fractures were treated operatively due to fracture displacement, and three were treated conservatively. The B2 and B3 fractures were managed with long, uncemented, revision stems because of a disrupted bone-prosthesis interface. All fractures healed well. This study confirms that the modified algorithm of management of periprosthetic fractures, using the Vancouver classification, is a simple, reproducible, classification system for uncemented prostheses. Conservative treatment is a valid option if the implant is stable whilst surgical intervention is mandatory if the implant is loose.
我们在619例羟基磷灰石涂层髋关节植入物中研究了14例假体周围股骨骨折，并使用温哥华分类法将结果与已发表的治疗算法进行比较。有5例A型骨折、6例B1型、2例B2型和1例B3型骨折。除1例A型骨折外，其余均采用保守治疗。与温哥华分类法相比，我们在B型骨折中观察到了不同的骨折类型。与骨水泥型植入物不同，未发现柄尖处骨折。3例B1型骨折因骨折移位接受手术治疗，3例接受保守治疗。由于骨-假体界面破坏，B2型和B3型骨折采用长柄、非骨水泥型翻修柄进行处理。所有骨折均愈合良好。本研究证实，使用温哥华分类法的改良假体周围骨折处理算法是一种针对非骨水泥型假体的简单、可重复的分类系统。如果植入物稳定，保守治疗是一种有效的选择；而如果植入物松动，则必须进行手术干预。
