Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
Department of Orthopedic Surgery, Auckland District Health Board, Auckland, New Zealand.
J Arthroplasty. 2019 Jul;34(7):1430-1434. doi: 10.1016/j.arth.2019.03.003. Epub 2019 Mar 8.
The aim of this study is to assess the outcomes of 52 consecutive Vancouver B2 peri-prosthetic fractures around cemented polished double-tapered stems treated by open reduction and internal fixation in 2 trauma centers in 2 countries.
Outcomes included modified Harris Hip Score (mHHS), Harris Pain Score, and return to pre-injury mobility. Fracture healing was assessed; implant subsidence measured and complications including re-operations reported.
No patient was lost to follow-up. Median patient age at operation was 82 years (range 43-98); Harris pain scores showed minimal pain (median 42, range 10-44) at latest follow-up. Median total subsidence at 1 year was 1.1 mm (range 0-5.4), the majority of which occurred within the cement mantle. No subsequent femoral stem revision was required (median 2.9 years, 0-10); however, there were 3 re-operations: 1 re-operation for pre-existing recurrent dislocation involving head liner exchange and 2 for repeat fixation due to metal fatigue. Two additional fractures occurred below the new plating, requiring further plating whilst still retaining the original stems.
Anatomical reduction and open reduction and internal fixation of Vancouver B2 peri-prosthetic fractures should be considered as an appropriate treatment solution for frail elderly patients with a peri-prosthetic fracture around cemented polished double-tapered stems.
本研究旨在评估在两国 2 家创伤中心，对 52 例连续的温哥华 B2 型假体周围骨折患者（均使用骨水泥固定抛光双锥形柄假体）采用切开复位内固定治疗的结果。
评估指标包括改良 Harris 髋关节评分（mHHS）、Harris 疼痛评分以及恢复至伤前活动能力情况。评估骨折愈合情况，测量假体下沉程度，报告包括再次手术在内的并发症。
无患者失访。手术时患者的中位年龄为 82 岁（范围 43-98 岁）；末次随访时 Harris 疼痛评分为中度疼痛（中位数 42，范围 10-44）。1 年时的总下沉中位数为 1.1 毫米（范围 0-5.4），其中大部分发生在骨水泥覆盖层内。无后续股骨柄翻修（中位随访时间 2.9 年，范围 0-10 年）；但有 3 例再次手术：1 例因先前存在复发性脱位而行内衬更换，2 例因金属疲劳而行重复固定。另外 2 例骨折发生在新钢板下方，需要进一步固定钢板，同时保留原假体。
对于使用骨水泥固定抛光双锥形柄假体周围发生假体周围骨折的体弱老年患者，解剖复位及切开复位内固定可作为一种合适的治疗方案。
