Rothman Institute Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Ann Transl Med. 2015 Sep;3(16):234. doi: 10.3978/j.issn.2305-5839.2015.09.32.
Management of periprosthetic fractures around the femoral stem after total hip arthroplasty (THA) represents a significant challenge and optimal treatment remains controversial. The most common treatment paradigm involves treating fractures around a well-fixed stem with osteosynthesis, whereas fractures around a loose stem require revision arthroplasty and those with poor bone require augmentation with bone graft. Paradoxically, the literature reports a higher rate of failure for osteosynthesis around prostheses considered to be well-fixed. Such a high rate of poor outcomes may result not only from difficult fracture fixation and compromised biologic healing, but also from unrecognized peri-implant pathology. Therefore, proper preoperative and intraoperative evaluation is key, and a subset of patients may benefit from alternative management. We review the appropriate methods for evaluation and treatment of Vancouver type B fractures with particular emphasis on avoiding missteps that can lead to failure.
全髋关节置换术后股骨柄周围假体周围骨折的处理是一个重大挑战，其最佳治疗方法仍存在争议。最常见的治疗方案是通过骨接合术治疗固定良好的假体周围骨折，而对于松动的假体周围骨折需要进行翻修关节置换术，对于骨量差的骨折需要进行骨移植增强。矛盾的是，文献报告认为固定良好的假体周围骨接合术失败率更高。如此高的不良结果发生率不仅可能是由于骨折固定困难和生物愈合受损所致，还可能是由于未识别的种植体周围病理学所致。因此，适当的术前和术中评估是关键，一部分患者可能受益于替代治疗。我们回顾了温哥华 B 型骨折的适当评估和治疗方法，特别强调避免可能导致失败的错误步骤。
