Department of Orthopaedic Surgery, Keimyung University, Dongsan Medical Center, 194 Dongsan-dong, Joong-gu, Daegu 41931 South Korea.
Injury. 2018 Jul;49(7):1336-1340. doi: 10.1016/j.injury.2018.05.020. Epub 2018 May 22.
Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) remain one of the most challenging complications to address. Although the principal treatment modalities for Vancouver type B1 fractures are open reduction and internal fixation (ORIF), surgeons have not yet reached a consensus on the optimal method for reduction and fixation. We therefore investigated whether minimally invasive plate osteosynthesis (MIPO) using locking compression plate (LCP) would lead to favorable outcomes for patients with Vancouver type B1 PFFs. In addition, we also compared the outcomes of patients treated with MIPO to those treated with ORIF.
We retrospectively evaluated the clinical and radiographic outcomes of a series of 21 Vancouver type B1 PFFs treated with MIPO and LCP between February 2011 and February 2017. The mean duration of follow-up was 33.8 months. We also compared outcomes of these patients to those of patients with 19 Vancouver type B1 fractures treated with ORIF between April 2006 and December 2011.
Fracture healing without complications was achieved in 20 (95.2%) out of 21 cases in the MIPO group and in 14 (87.5%) out of 16 cases in the ORIF group. There was one case of fixation failure with stem subsidence in the MIPO group. In the ORIF group, there were 2 nonunion with metal failure. Operation time was significantly shorter and intraoperative blood loss was significantly less in the MIPO group compared to the ORIF group. However, there were no significant differences in frequency of transfusion, time-to-union, walking abilities, modified Harris hip score, or complications.
The radiological and clinical outcomes of MIPO using LCP in patients with Vancouver type B1 PFFs were shown not to be inferior to ORIF and resulted in fewer intraoperative complications than ORIF. If care is taken regarding the stability of femoral implant and optimal surgical techniques, MIPO may be a recommended option in the treatment of Vancouver type B1 periprosthetic fracture.
全髋关节置换术后（THA）的股骨假体周围骨折（PFF）仍然是最具挑战性的并发症之一。尽管 Vancouver B1 型骨折的主要治疗方法是切开复位内固定（ORIF），但外科医生尚未就最佳复位和固定方法达成共识。因此，我们研究了使用锁定加压钢板（LCP）的微创钢板接骨术（MIPO）是否会为 Vancouver B1 型 PFF 患者带来良好的结果。此外，我们还比较了接受 MIPO 治疗的患者和接受 ORIF 治疗的患者的结果。
我们回顾性评估了 2011 年 2 月至 2017 年 2 月期间使用 MIPO 和 LCP 治疗的 21 例 Vancouver B1 型 PFF 患者的临床和影像学结果。平均随访时间为 33.8 个月。我们还将这些患者的结果与 2006 年 4 月至 2011 年 12 月期间接受 ORIF 治疗的 19 例 Vancouver B1 型骨折患者的结果进行了比较。
在 MIPO 组的 21 例患者中有 20 例（95.2%）和 ORIF 组的 16 例患者中有 14 例（87.5%）无并发症愈合。MIPO 组有 1 例固定失败伴钉下沉。ORIF 组有 2 例骨折不愈合伴金属失败。与 ORIF 组相比，MIPO 组的手术时间明显更短，术中出血量明显更少。然而，在输血频率、愈合时间、行走能力、改良 Harris 髋关节评分和并发症方面无显著差异。
在 Vancouver B1 型 PFF 患者中，使用 LCP 的 MIPO 的影像学和临床结果并不逊于 ORIF，并且比 ORIF 产生更少的术中并发症。如果注意股骨植入物的稳定性和优化的手术技术，MIPO 可能是治疗 Vancouver B1 型假体周围骨折的推荐选择。
