Wilke Benjamin K, Spaulding Aaron C, Crowe Matthew M, Ledford Cameron K, Sherman Courtney E, Spencer-Gardner Luke, Blasser Kurt E
Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL.
Department of Biostatistics, Mayo Clinic, Jacksonville, FL.
Arthroplast Today. 2024 Jun 14;28:101444. doi: 10.1016/j.artd.2024.101444. eCollection 2024 Aug.
Management of periprosthetic fractures has been guided by the Vancouver classification, which recommends revision for fractures around a loose femoral implant (B2). New studies have challenged this approach, demonstrating acceptable outcomes with internal fixation. This study evaluates our experience with Vancouver B2 fractures, comparing internal fixation to femoral revision. We hypothesized that in select cases with cementless stems, internal fixation would provide acceptable results with reduced morbidity.
A retrospective review was performed of periprosthetic hip fractures treated at our institution between 1 January 2012 and 4 November 2022. We excluded patients who did not have prior radiographs and evidence of stem subsidence, suggestive of a Vancouver B2 fracture. Thirteen patients were included in the analysis.
Four patients (31%) underwent revision of the femoral component, 4 patients (31%) underwent plating, and 5 patients (38%) underwent internal fixation with cerclage cabling. The average operative duration was 158 minutes, 203 minutes, and 62 minutes for the revision, plating, and cabling cohorts, respectively ( = .009). Blood loss was 463 cc, 510 cc, and 90 cc for the revision, plating, and cabling cohorts, respectively ( = .036). Three patients in both the revision and plating cohorts each received a transfusion (75%), whereas no patients in the cabling cohort required a transfusion ( = .033). All patients demonstrated fracture healing on the postoperative radiographs. No patients required additional surgery during the follow-up period.
We have demonstrated that Vancouver B2 periprosthetic fractures with intact lateral cortices may be treated with internal fixation with cerclage cabling with excellent results.
人工关节周围骨折的处理一直以温哥华分类法为指导，该分类法建议对股骨假体周围松动的骨折（B2型）进行翻修。新的研究对这种方法提出了挑战，表明内固定可取得可接受的结果。本研究评估了我们处理温哥华B2型骨折的经验，比较了内固定与股骨翻修的效果。我们假设，在某些使用非骨水泥型股骨柄的病例中，内固定能取得可接受的结果且并发症更少。
对2012年1月1日至2022年11月4日在我院治疗的人工关节周围髋部骨折进行回顾性研究。我们排除了没有术前X线片以及无股骨柄下沉证据（提示温哥华B2型骨折）的患者。13例患者纳入分析。
4例患者（31%）接受了股骨假体翻修，4例患者（31%）接受了钢板固定，5例患者（38%）接受了环扎钢缆内固定。翻修组、钢板固定组和环扎钢缆内固定组的平均手术时间分别为158分钟、203分钟和62分钟（P = 0.009）。翻修组、钢板固定组和环扎钢缆内固定组的失血量分别为463毫升、510毫升和90毫升（P = 0.036）。翻修组和钢板固定组各有3例患者接受了输血（75%），而环扎钢缆内固定组无患者需要输血（P = 0.033）。所有患者术后X线片均显示骨折愈合。随访期间无患者需要再次手术。
我们证明，外侧皮质完整的温哥华B2型人工关节周围骨折可采用环扎钢缆内固定治疗，效果良好。
