Schreiner Anna Janine, Steidle Christoph, Schmidutz Florian, Gonser Christoph, Hemmann Philipp, Stöckle Ulrich, Ochs Gunnar
Department of Arthroplasty, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen.
Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU).
Z Orthop Unfall. 2022 Feb;160(1):40-48. doi: 10.1055/a-1209-4002. Epub 2020 Aug 3.
Periprosthetic fractures Vancouver type B2/B3 after total hip arthroplasty (THA) is a challenging entity with increasing numbers. Limited data are available for this type of fracture treated with modular stems. Therefore, this study evaluated the outcome of Vancouver type B2/B3 fractures treated with a modular hip revision stem using a subproximal/distal anchorage and compared it to the current literature.
A consecutive series of periprosthetic Vancouver type B2/B3 fractures treated with a modular revision stem was retrospectively (2013 - 2016) evaluated. Assessment included the clinical (HHS, pain, ROM) as well as the radiological outcome (subsidence, loosening, facture healing). In adddition, the surgical technique is described in detail and results are compared with the current literature.
A total of 18 patients (female/male 12/6) with Vancouver B2/B3 (n = 12/6) fractures with a mean age of 75.5 (60 - 89) years were included. The revision stem was inserted via a modified transgluteal approach (n = 16) or classical transfemoral approach (n = 2). The mean follow-up was 18.5 months, with a mean Harris Hip Score of 72.5 ± 18.7 (35.0 - 99.0) points. The fracture healing rate was 94.4% (n = 17) with osseous integration according to Engh in all cases. Dislocations of the greater trochanter were recorded in seven patients (38.9%). According to Beals and Towers, all results were rated excellent or good. No implant-related failure or relevant subsidence during this time was observed. Major complications were observed in five patients with two periprosthetic joint infections and two cases of major revision surgery.
This study assessing Vancouver B2/3 fractures shows reproducible, good, short-term results in terms of subsidence and clinical functional outcome by the use of a modular revision stem. The transfemoral approach together with the modular stem allows for a stable fixation and good fracture healing. However, our data and review of the literature also documents the difficulties and higher complication rate associated with Vancouver B2/3 fractures.
全髋关节置换术（THA）后温哥华B2/B3型假体周围骨折是一个数量不断增加且具有挑战性的问题。关于使用模块化柄治疗这类骨折的数据有限。因此，本研究评估了采用近端/远端锚固的模块化髋关节翻修柄治疗温哥华B2/B3型骨折的结果，并与当前文献进行比较。
回顾性评估了2013年至2016年连续一系列采用模块化翻修柄治疗的温哥华B2/B3型假体周围骨折。评估包括临床指标（髋关节Harris评分、疼痛、活动度）以及放射学结果（下沉、松动、骨折愈合）。此外，详细描述了手术技术，并将结果与当前文献进行比较。
共纳入18例患者（女性12例，男性6例），患有温哥华B2/B3型骨折（n = 12/6），平均年龄75.5岁（60 - 89岁）。翻修柄通过改良经臀肌入路（n = 16）或经典经股骨入路（n = 2）插入。平均随访18.5个月，平均Harris髋关节评分为72.5 ± 18.7（35.0 - 99.0）分。骨折愈合率为94.4%（n = 17），所有病例根据Engh标准均实现骨整合。7例患者（38.9%）记录有大转子脱位。根据Beals和Towers标准，所有结果均评为优秀或良好。在此期间未观察到与植入物相关的失败或明显下沉。5例患者出现主要并发症，包括2例假体周围关节感染和2例大翻修手术。
本研究评估温哥华B2/3型骨折显示，使用模块化翻修柄在下沉和临床功能结果方面具有可重复的良好短期结果。经股骨入路结合模块化柄可实现稳定固定和良好的骨折愈合。然而，我们的数据和文献回顾也证明了与温哥华B2/3型骨折相关的困难和较高并发症发生率。
