Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China.
Bone Joint J. 2020 Mar;102-B(3):293-300. doi: 10.1302/0301-620X.102B3.BJJ-2019-0935.R1.
Vancouver type B periprosthetic femoral fractures (PFF) are challenging complications after total hip arthroplasty (THA), and some treatment controversies remain. The objectives of this study were: to evaluate the short-to-mid-term clinical outcomes after treatment of Vancouver type B PFF and to compare postoperative outcome in subgroups according to classifications and treatments; to report the clinical outcomes after conservative treatment; and to identify risk factors for postoperative complications in Vancouver type B PFF.
A total of 97 consecutive PPFs (49 males and 48 females) were included with a mean age of 66 years (standard deviation (SD) 14.9). Of these, 86 patients were treated with surgery and 11 were treated conservatively. All living patients had a minimum two-year follow-up. Patient demographics details, fracture healing, functional scores, and complications were assessed. Clinical outcomes between internal fixation and revisions in patients with or without a stable femoral component were compared. Conservatively treated PPFs were evaluated in terms of mortality and healing status. A logistic regression analysis was performed to identify risk factors for complications.
In surgically treated patients, all fractures united and nine complications were identified. The mean postoperative Visual Analogue Scale (VAS) for pain was 1.5 (SD 1.3), mean Parker Mobility Score (PMS) was 6.5 (SD 2.4), and mean Harris Hip Score (HHS) was 79.4 (SD 16.2). Among type B2 and type B3 fractures, patients treated with internal fixation had significantly lower PMS (p = 0.032) and required a longer time to heal (p = 0.012). In conservatively treated patients, one-year mortality rate was 36.4% (4/11), and two patients ultimately progressed to surgery. Young age (p = 0.039) was found to be the only risk factor for complications.
The overall clinical outcome among Vancouver type B PFF was satisfactory. However, treatment with internal fixation in type B2 and B3 fractures had a significantly longer time to heal and lower mobility than revision cases. Conservative treatment was associated with high rates of early mortality and, in survivors, nonunion. This probably reflects our selection bias in undertaking surgical intervention. In our whole cohort, younger patient age was a risk factor for postoperative complications in Vancouver type B PFF. Cite this article: 2020;102-B(3):293-300.
温哥华 B 型假体周围股骨骨折（PFF）是全髋关节置换术后（THA）的一种具有挑战性的并发症，一些治疗仍存在争议。本研究的目的是：评估温哥华 B 型 PFF 治疗后的短期至中期临床结果，并根据分类和治疗方法对术后结果进行亚组比较；报告保守治疗后的临床结果；并确定温哥华 B 型 PFF 术后并发症的危险因素。
共纳入 97 例连续的 PFF（49 名男性和 48 名女性），平均年龄为 66 岁（标准差（SD）为 14.9）。其中 86 例患者接受手术治疗，11 例患者接受保守治疗。所有存活患者的随访时间均至少为 2 年。评估患者的人口统计学资料、骨折愈合情况、功能评分和并发症情况。比较有或无稳定股骨组件的患者中内固定与翻修的临床结果。评估接受保守治疗的 PFF 的死亡率和愈合情况。采用 logistic 回归分析确定并发症的危险因素。
在接受手术治疗的患者中，所有骨折均愈合，发现 9 例并发症。术后视觉模拟评分（VAS）平均为 1.5（SD 1.3），帕克移动评分（PMS）平均为 6.5（SD 2.4），Harris 髋关节评分（HHS）平均为 79.4（SD 16.2）。在 B2 型和 B3 型骨折中，接受内固定治疗的患者 PMS 明显较低（p = 0.032），且愈合时间较长（p = 0.012）。在接受保守治疗的患者中，1 年死亡率为 36.4%（4/11），其中 2 例最终转为手术治疗。发现年轻的年龄（p = 0.039）是唯一的并发症危险因素。
温哥华 B 型 PFF 的总体临床结果令人满意。然而，B2 型和 B3 型骨折的内固定治疗愈合时间和活动度明显低于翻修病例。保守治疗与早期死亡率高相关，且幸存者存在骨折不愈合。这可能反映了我们在进行手术干预时的选择偏倚。在我们的整个队列中，年轻患者年龄是温哥华 B 型 PFF 术后并发症的危险因素。
2020;102-B(3):293-300.
