Li Hu, Wei Wei, Lin Jian-hao, Kou Bo-long
Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2012 Jan 1;50(1):28-31.
To discuss the treatment and clinical result of using titanium cerclage band to teat intra- and post-operative femoral fracture in total hip arthroplasty.
From August 1999 to September 2007, twenty-two patients who suffered from intra-and post-operative femoral oblique fracture in total hip arthroplasty were reviewed among 2186 consecutive total hip arthroplasty patients performed by one surgeon. There were 12 fractures occurred intraoperative and 10 fractures postoperative. There are 9 primary and 13 revision total hip arthroplasty patients including 10 men and 12 women. All fractures are classified as Vancouver B1 type in 15 cases and B2 type in 7 cases. Two to five titanium cerclage bands had been used to fix the fracture followed by open reduction with 13 cases using 2 cerclage bands and 7 cases using 3 bands and 1 case using 4 bands and 1 case using 5 bands. Whether change the original stem or not depended on the classification of fractures and stability of stems. There were 15 cases of type B1 and 1 case of type B2 without changing stems and 6 cases of type B2 changing to revision stems of the same series of original stems.
All fractures showed successfully union for 12 - 20 weeks (average 18 weeks) after operation. The average Harris score of the hip improved to 90 points (80 to 95 points) at an average 6.5 years follow-up (4 to 11 years) and the average range of motion of the hip got to 120° (105° - 135°). Femoral prostheses were well-fixed without any subsidence or lucent lines or loosening. All patients were satisfied with the results with well-fixed and good alignment of femoral stem.
Strong fixation of the fractures and good initial stability of femoral stem can be obtained using titanium cerclage bands to fix the intra- and post-operative femoral oblique fracture. Original stems should be changed to revision stems in case of type B2 and be retained in case of type B1.
探讨采用钛环扎带治疗全髋关节置换术中及术后股骨骨折的治疗方法及临床效果。
回顾1999年8月至2007年9月间，由同一外科医生连续进行的2186例全髋关节置换术患者中，22例发生全髋关节置换术中及术后股骨斜形骨折的患者。其中术中骨折12例，术后骨折10例。初次全髋关节置换术9例，翻修手术13例，包括男性10例，女性12例。所有骨折按温哥华分型，B1型15例，B2型7例。使用2至5根钛环扎带固定骨折，随后进行切开复位，其中13例使用2根环扎带，7例使用3根，1例使用4根，1例使用5根。是否更换原假体柄取决于骨折分型及假体柄的稳定性。B1型15例及B2型1例未更换假体柄，B2型6例更换为同系列原假体柄的翻修假体柄。
所有骨折术后12至20周（平均18周）均成功愈合。平均随访6.5年（4至11年）时，髋关节Harris评分平均提高至90分（80至95分），髋关节平均活动范围达到120°（105°至135°）。股骨假体固定良好，无下沉、透亮线或松动。所有患者对股骨柄固定良好及对线良好的结果满意。
使用钛环扎带固定全髋关节置换术中及术后股骨斜形骨折，可获得骨折的牢固固定及股骨柄良好的初始稳定性。B2型骨折应更换为翻修假体柄，B1型骨折应保留原假体柄。
