Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Trauma Related Services, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; and.
J Orthop Trauma. 2022 Aug 1;36(8):e306-e311. doi: 10.1097/BOT.0000000000002354. Epub 2022 Feb 11.
To determine whether open reduction and internal fixation (ORIF) of periprosthetic Vancouver B2 fractures can lead to successful fracture healing in selected patients, when attention is given to the surgical exposure and the creation of a balanced extramedullary construct.
Retrospective.
Two Level-1 trauma centers in Germany and United Kingdom.
Patients with a B2 fracture receiving solely ORIF using a polyaxial locking plate were included for analysis. Patients with other fracture types, or treated with other methods, or with follow-up less than 12 months were excluded. Clinical characteristics, including the Charlson index, the American Society for Anesthesiologists score, and their preinjury functional levels, were recorded. Main outcome measures were 1-year mortality, revision rate, and radiological healing according to the Beals-Tower criteria.
A total of 32 patients (mean age ,79 ± 12 years) were enrolled. Six patients died within the first year (1-year mortality: 19%), and 5 were unavailable for follow-up studies. The remaining 21 patients had a mean follow-up of 30 months. Of 21, 20 had an excellent/good result using the criteria of Beals-Tower. One patient required revision surgery due to loosening and secondary subsidence of the stem.
ORIF can be offered to selected patients suffering from B2 fractures, especially if their functional demand is limited, and perioperative risk high for revision arthroplasty. In this challenging cohort of patients, ORIF was a safe and effective therapeutic option.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
探讨在关注手术显露和构建平衡髓外固定结构的情况下，对于特定患者，切开复位内固定（ORIF）能否成功治疗假体周围 Vancouver B2 骨折。
回顾性研究。
德国和英国的 2 家 1 级创伤中心。
仅接受多轴锁定钢板 ORIF 的 B2 骨折患者纳入分析。排除其他骨折类型、接受其他治疗方法或随访时间＜12 个月的患者。记录患者的临床特征，包括 Charlson 指数、美国麻醉医师协会评分及其伤前功能水平。主要结局指标为 1 年死亡率、翻修率以及根据 Beals-Tower 标准评估的影像学愈合情况。
共纳入 32 例患者（平均年龄 79±12 岁）。6 例患者在 1 年内死亡（1 年死亡率：19%），5 例失访。其余 21 例患者的平均随访时间为 30 个月。21 例患者中，根据 Beals-Tower 标准，20 例患者的结果为优/良。1 例患者因假体松动和继发性下沉行翻修手术。
对于功能需求有限且翻修关节置换术围手术期风险高的 B2 骨折患者，可选择切开复位内固定。对于这群具有挑战性的患者，切开复位内固定是一种安全有效的治疗选择。
治疗性 IV 级。欲了解完整的证据分级说明，请参见作者须知。
