Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Injury. 2013 Nov;44(11):1556-60. doi: 10.1016/j.injury.2013.04.025. Epub 2013 Jun 10.
This study was designed to compare the outcome of two surgical approaches for treating femoral periprosthetic fractures around a stable femoral stem. The hypothesis was that plate fixation alone might be associated with a higher complication rate due to insufficient mechanical stability. We also considered that the addition of a strut allograft would contribute to fracture healing by means of osteoconduction.
We retrospectively assessed the outcome of 21 patients who sustained periprosthetic fractures around a total hip replacement system (Vancouver type B1 and type C fractures) and who were treated in our department (January 2006 and August 2011) either by plate fixation alone or by plate fixation and a strut allograft. The mean postoperative follow-up was 23 months (range 9-69 months). Eleven patients were treated by plate fixation alone (Plate Group), and 10 patients were treated by plate fixation and a deep frozen cortical strut allograft (AG Group). Functional outcome was rated by the Harris Hip scoring system. Postoperative radiographs were assessed for evidence of fracture union. Surgical failure was defined as any complication requiring surgical revision.
The 21 patients included 17 females and 4 males. The average age was 79 years (range, 73-88) for the Plate Group and 82 years (range, 53-94) for the AG Group, and the average time to fracture union was 12 weeks (range, 2.5-6 months) and 12.95 weeks (range, 1.5-3) respectively. The overall failure rate was significantly higher in the Plate Group: 5 of them required revision surgery compared to none in the AG Group (p=0.014).
The results of this analysis indicate that a strut allograft augmentation approach to Vancouver type B1 and type C periprosthetic fractures results in a better outcome than plate fixation alone by apparently adding mechanical stability and enhancing the biological healing process.
本研究旨在比较两种手术方法治疗稳定股骨柄周围股骨假体周围骨折的疗效。我们假设单独使用钢板固定可能会由于机械稳定性不足而导致更高的并发症发生率。我们还认为，使用支撑同种异体骨移植会通过骨传导促进骨折愈合。
我们回顾性评估了 21 例在我院（2006 年 1 月至 2011 年 8 月）接受治疗的全髋关节置换系统周围假体周围骨折（温哥华 B1 型和 C 型骨折）患者的结果，他们分别接受了单独钢板固定或钢板固定和支撑同种异体骨移植治疗。平均术后随访时间为 23 个月（9-69 个月）。11 例患者接受单独钢板固定治疗（钢板组），10 例患者接受钢板固定和深冻皮质支撑同种异体骨移植治疗（AG 组）。采用 Harris 髋关节评分系统评定功能结果。术后 X 线片评估骨折愈合情况。手术失败定义为任何需要手术修正的并发症。
21 例患者中，女性 17 例，男性 4 例。钢板组的平均年龄为 79 岁（73-88 岁），AG 组为 82 岁（53-94 岁），骨折愈合的平均时间分别为 12 周（2.5-6 个月）和 12.95 周（1.5-3 个月）。钢板组的总体失败率明显较高：5 例需要手术修正，而 AG 组无手术修正（p=0.014）。
本分析结果表明，支撑同种异体骨移植增强术治疗温哥华 B1 型和 C 型假体周围骨折的疗效优于单纯钢板固定，明显增加了机械稳定性并增强了生物愈合过程。
