Princess Elizabeth Orthopaedic Centre, Exeter, Devon, UK.
Orthopaedic Research Unit, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
Bone Joint J. 2021 Jan;103-B(1):71-78. doi: 10.1302/0301-620X.103B1.BJJ-2020-0163.R1.
Periprosthetic fractures (PPFs) around cemented taper-slip femoral prostheses often result in a femoral component that is loose at the prosthesis-cement interface, but where the cement-bone interface remains well-fixed and bone stock is good. We aim to understand how best to classify and manage these fractures by using a modification of the Vancouver classification.
We reviewed 87 PPFs. Each was a first episode of fracture around a cemented femoral component, where surgical management consisted of revision surgery. Data regarding initial injury, intraoperative findings, and management were prospectively collected. Patient records and serial radiographs were reviewed to determine fracture classification, whether the bone cement was well fixed (B2W) or loose (B2L), and time to fracture union following treatment.
In total, 47 B2W fractures (54.0%) and one B3 fracture (1.1%) had cement that remained well-fixed at the cement-bone interface. These cases were treated with cement-in-cement (CinC) revision arthroplasty. Overall, 43 fractures with follow-up united, and two patients sustained further fractures secondary to nonunion and required further revision surgery. A total of 19 B2L fractures (21.8%) and 19 B3 fractures (21.8%) had cement that was loose at the cement-bone interface. These cases were managed by revision arthroplasty with either cemented or uncemented femoral components, or proximal femoral arthroplasty. One case could not be classified.
We endorse a modification of the original Vancouver system to include a subclassification of B2 fractures around cemented femoral prostheses to include B2W (where cement is well-fixed to bone) and B2L (where the cement is loose). Fractures around taper-slip design stems are more likely to fracture in a B2W pattern compared to fractures around composite beam design stems which are more likely to fracture in a B2L pattern. B2W fractures can reliably be managed with CinC revision. Cite this article: 2021;103-B(1):71-78.
黏合式锥形骨水泥股骨假体周围的假体周围骨折（PPF）常导致假体-骨水泥界面处股骨部件松动，但骨水泥-骨界面保持良好固定且骨质良好。我们旨在通过对温哥华分类系统进行修改，来了解如何对这些骨折进行最佳分类和管理。
我们回顾了 87 例 PPF。这些都是第一次发生在黏合式股骨部件周围的骨折，手术治疗包括翻修手术。我们前瞻性收集了初始损伤、术中发现和治疗的相关数据。通过查阅病历和连续的影像学检查，来确定骨折的分类、骨水泥是否固定良好（B2W）或松动（B2L）以及治疗后骨折愈合的时间。
共有 47 例 B2W 骨折（54.0%）和 1 例 B3 骨折（1.1%）的骨水泥在骨水泥-骨界面仍保持固定良好。这些病例采用骨水泥内翻修关节成形术（CinC）治疗。总的来说，43 例有随访的骨折愈合，2 例患者因骨折不愈合而再次发生骨折，需要进一步翻修手术。共有 19 例 B2L 骨折（21.8%）和 19 例 B3 骨折（21.8%）的骨水泥在骨水泥-骨界面松动。这些病例通过使用黏合或非黏合式股骨部件或股骨近端关节成形术进行翻修关节成形术治疗。有 1 例病例无法分类。
我们支持对原始温哥华系统进行修改，包括在黏合式股骨假体周围的 B2 骨折中增加一个亚分类，包括 B2W（骨水泥与骨固定良好）和 B2L（骨水泥松动）。与复合材料梁设计柄的假体周围骨折相比，锥形骨水泥股骨假体柄周围的假体周围骨折更可能呈现 B2W 模式，而复合材料梁设计柄的假体周围骨折更可能呈现 B2L 模式。B2W 骨折可以通过 CinC 翻修可靠地治疗。
2021;103-B（1）：71-78.
