全髋关节置换术后股骨假体周围Vancouver B型骨折治疗的随访研究

摘要

目的 探讨全髋关节置换术后股骨假体周围Vancouver B型骨折治疗方法的选择,总结同种异体皮质骨板移植重建股骨假体周围骨折的临床效果.方法 22例全髋关节置换术后股骨假体周围骨折患者,男7例,女15例;年龄平均65岁(53～75岁).Vancouver分类B1型5例,B2型4例,B3型13例.B1型骨折采用异体皮质骨板移植加钢丝环扎治疗;B2型骨折选择加长股骨柄翻修;B3型骨折选择骨水泥柄翻修,加同种异体皮质骨板移植和钢丝环扎同定.所有患者均获得随访,随访时间平均67个月(37～95个月).采用Harris髋关节功能评分、X线片、外周血T淋巴细胞亚群、抗体免疫复合物检测 和核素骨显像对治疗结果进行评价.结果 22例患者骨折全部愈合,21例患者能自由行走,1例需要助 行器帮助.末次随访Harris评分平均89分(79～93分).患者未发生免疫排斥反应;术后3个月,骨折愈合,术后12个月,移植骨板与宿主骨骨性愈合,股骨皮质厚度增加3～5mm;核素骨显像骨板移植区放射性核素分布较对侧浓集.3例患者移植骨板出现部分吸收现象.术后2年.骨板与宿主骨融合,移植骨板吸收停止.结论 针对股骨假体周围骨折不同类型分别采取不同方法治疗能够取得较好疗效,同种异体皮质骨板移植在维持骨折稳定性、促进骨折愈合、增加局部骨量和改善骨强度方面有较好疗效.%Objective To discuss the methods of treating Vancouver type B periprosthetic femoral fractures after total hip arthroplasty and observe the clinical results to reconstruct the periprosthetic fractures with cortical bone plate allografts. Methods Twenty-two patients (7 males and 15 females, mean age, 65 years; range, 53-75 years) with Vancouver type B periprosthetic femoral fractures were treated. Five type B1 cases underwent open reduction and allograft strut, 4 type B2 patients underwent open reduction and revision with a long uncement or cement stems, and 13 type B3 cases underwent open reduction and revision with a long cement stem, and bone allograft. The mean duration of follow-up was 67 months. T lymphocytes, Harris score, radiographs and bone scintigraphy were used to evaluate the outcomes. Results Twenty-two cases got fracture healing, no stem loosening, immunity rejection and infection in all patients. Twenty-one cases were able to walk and 1 patient required a walking aid. The mean Harris score, was 89 at final follow-up. X-ray film indicated that fracture was healed at the 3rd months. Osseous union of the allagraft to the host femur occurred, the cortex of host femur was more thick 3-5 mm compared preoperation, and the nuclein distribution in the area of allograft cortical bone plates was more concentrated compared the contralateral at the 12nd month postoperatively. Three cases allograft strut was partieally absorbed 12 months after surgery, however, the absorption stopped, and allograft plates being incorporation to host bone at the 24th month postoperatively. Ten degrees deformity laterally was found for 1 case with type B,. Conclusion The treatment methods should depend on the type of periprosthetic femoral fractures in order to get good outcome. It can provide a satisfactory result using allogral't strut for treating Vancouver type B periprosthetic femoral fractures, which can not only maintain fracture stability, but also improve fracture healing, host bone augmentation.