González-Martín David, González-Casamayor Sergio, Herrera-Pérez Mario, Guerra-Ferraz Ayron, Ojeda-Jiménez Jorge, Pais-Brito José Luis
Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Universidad de La Laguna, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
J Clin Med. 2021 Nov 14;10(22):5288. doi: 10.3390/jcm10225288.
Although stem revision is recommended for Vancouver B2 periprosthetic hip fractures (PPHFs), there has recently been a debate whether, under certain conditions, they could be treated by osteosynthesis alone. This study aimed to describe the medium-term clinical and radiological results of several patients with V-B2 fractures treated via osteosynthesis. A retrospective study of patients with V-B2 PPHF treated by osteosynthesis without stem revision, operated on between 2009 and 2019, was performed. The type of arthroplasty, type of stem, ASA, Charlson Comorbidity Index (CCI), medical and implant complications, reoperation rate, first-year mortality, radiological results (consolidation time), and functional results were analyzed. Thirty-nine patients were included. Their average age was 78.82 years. Most of the patients presented ASA ≥ 3 (35/39) and CCI ≥ 5 (32/39). Radiological consolidation was achieved in 93.5% of patients, with an average consolidation time of 92.93 days. The average Parker test score before admission was 5.84 while the current one was 4.92 (5.16 years follow-up). Osteosynthesis without stem revision is a valid surgical alternative in certain types of patients with V-B2 PPHF, depending on previous mobility, fracture pattern (anatomical reconstruction possible), anesthetic risk, comorbidities, and previous hip pain.
虽然对于温哥华B2型假体周围髋关节骨折（PPHFs）推荐进行翻修柄手术，但最近对于在某些情况下能否仅通过骨合成进行治疗存在争议。本研究旨在描述数例通过骨合成治疗的V-B2型骨折患者的中期临床和影像学结果。对2009年至2019年间接受骨合成而非翻修柄手术治疗的V-B2型PPHF患者进行了一项回顾性研究。分析了关节置换类型、柄的类型、美国麻醉医师协会（ASA）分级、查尔森合并症指数（CCI）、医疗和植入物并发症、再次手术率、第一年死亡率、影像学结果（愈合时间）以及功能结果。纳入了39例患者。他们的平均年龄为78.82岁。大多数患者ASA分级≥3（35/39）且CCI≥5（32/39）。93.5%的患者实现了影像学愈合，平均愈合时间为92.93天。入院前平均帕克试验评分为5.84，而目前为4.92（随访5.16年）。对于某些类型的V-B2型PPHF患者，根据既往活动能力、骨折类型（可能进行解剖重建）、麻醉风险、合并症以及既往髋关节疼痛情况，不进行翻修柄的骨合成是一种有效的手术选择。
