Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Eur J Orthop Surg Traumatol. 2024 Jul;34(5):2573-2580. doi: 10.1007/s00590-024-03961-3. Epub 2024 May 2.
According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture.
A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients.
Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24 days; p = 0.037) and the time to full weight-bearing (21 days vs. 9 days; p < 0.001) were longer in the cementless stem group.
Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.
根据温哥华分类，B2 型骨折最常通过去除松动的柄和植入绕过骨折部位的长柄来治疗。然而，对于应使用何种柄固定存在争议：水泥固定或非水泥固定。因此，本研究旨在比较因温哥华 B2（VB2）假体周围髋部骨折行假体翻修时使用水泥固定和非水泥固定柄的效果。
对 2015 年至 2022 年期间在一家三级医院因 VB2 假体周围髋部骨折行柄置换的所有患者进行回顾性研究。根据使用的柄固定方式将患者分为水泥固定组和非水泥固定组。比较两组患者的功能结果、住院时间、手术时间、并发症发生率和死亡率。
30 例纳入患者中，13 例（43.4%）采用非水泥固定柄治疗，17 例（56.7%）采用水泥固定柄治疗。两组患者的年龄、性别、麻醉风险分级（ASA）或术前功能状态无统计学差异。与水泥固定组相比，非水泥固定组的并发症和再干预发生率更高：62%和 45%比 34%和 6%（p=0.035；p=0.010）。此外，非水泥固定组的非愈合比例更高（53.8%比 17.6%；p=0.037）。同时，非水泥固定组的住院时间（33 天比 24 天；p=0.037）和完全负重时间（21 天比 9 天；p<0.001）更长。
在 VB2 假体周围髋部骨折的假体翻修中，水泥固定可能是一种理想的选择，它能更快地恢复，降低并发症和再干预的发生率，同时不影响骨折愈合和患者死亡率。因此，在可以获得解剖复位的情况下，可以考虑这种选择，尤其是在有多种合并症的老年患者中，应考虑采用侵袭性较小的手术方式。
