温哥华B2型人工关节周围股骨骨折的治疗：翻修关节成形术与锁定加压钢板切开复位内固定术的比较
Treatment of Periprosthetic Femoral Fractures Vancouver Type B2: Revision Arthroplasty Versus Open Reduction and Internal Fixation With Locking Compression Plate.
作者信息
Baum C, Leimbacher M, Kriechling P, Platz A, Cadosch D
机构信息
Department of General, Hand and Trauma Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
出版信息
Geriatr Orthop Surg Rehabil. 2019 Sep 24;10:2151459319876859. doi: 10.1177/2151459319876859. eCollection 2019.
INTRODUCTION
The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment.
MATERIALS AND METHODS
Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated.
RESULTS
Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group.
DISCUSSION
Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous.
CONCLUSION
In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.
引言
温哥华算法推荐对温哥华B2型（VTB2）骨折进行翻修关节成形术（RA）。然而，使用锁定加压钢板（LCP）进行切开复位内固定（ORIF）可能是一种有效且侵入性较小的替代治疗方法。
材料与方法
2007年1月至2017年3月期间，我们回顾性招募了在我们诊所接受LCP ORIF或RA治疗VTB2骨折的所有患者。对以下所有内容进行了评估：住院时间、手术时间、手术期间和/或手术后输血需求、植入物相关和患者相关并发症、翻修手术需求以及放射学结果。此外，还对功能结果进行了调查。
结果
共招募了59例患者。35例（59.3%）患者接受了RA，而24例（40.7%）患者接受了LCP ORIF。LCP组的中位手术时间为137.50分钟，而RA组为160.00分钟（P = 0.051）。LCP组有3例（12.5%）患者和RA组有10例（28.6%）患者发生了植入物相关并发症（P = 0.131）。LCP组有3例（12.5%）患者发生了患者相关并发症，而RA组有6例（17.1%）患者发生了此类并发症（P = 0.628）。两组术前帕克活动度评分平均均为9分，术后两组均下降，LCP组平均降至5分，RA组平均降至7分。
讨论
与RA相比，LCP切开复位内固定对于VTB2骨折似乎是一种侵入性较小的手术。这是一种保留骨质的手术，对进一步的翻修手术可能有利。此外，一些骨折只能通过LCP ORIF进行解剖复位，而对于近端骨折且放射学上明确显示假体柄松动的情况，RA可能更具优势。
结论
与先前发表的研究一致，我们的数据表明，使用LCP进行ORIF是治疗VTB2骨折的一种有效选择。
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