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Abstract：
OBJECTIVE: Periprosthetic femoral fractures (PPFs) around the hip are challenging complications in orthopaedic surgery, particularly Vancouver type B2 (VTB2) fractures. The surgical management of these fractures is crucial and depends on various factors. Cementless short taper stem with plate osteosynthesis is an alternative surgical technique. This study aims to compare the outcomes of this surgical technique with revision arthroplasty (RA) with long stem in the treatment of VTB2 PPFs.
METHODS: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups.
RESULTS: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups.
CONCLUSIONS: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.
METHODS: This retrospective study was conducted in a single medical institute from February 2010 to May 2019. Patients who had received either total hip arthroplasty or bipolar hemiarthroplasty and subsequently developed a VTB2 PPF were included; patients who sustained intra-operative fractures or received a cemented stem previously were excluded from the analysis. The patients were divided into two groups: group I received RA with cementless long stem, while group II underwent RA with cementless short taper stem with plate osteosynthesis. Demographic data, radiographic and functional outcomes, and complications were analyzed between the two groups.
RESULTS: A total of 85 patients diagnosed with VTB2 PPFs were included in the study. There were no significant differences between the two groups in terms of demographic data, including age, gender, mean follow-up times, estimated blood loss, and operative times. The radiographic results showed that there was no significant difference in the incidence of subsidence and implant stability between the two groups. However, group II tended to have less subsidence and periprosthetic osteolysis. Patients in group II had significantly better functional scores (mean Harris hip score: post-operative: 60.2 in group I and 66.7 in group ii; last follow-up: 77.4 in group 1 and 83.2 in group II (both p < 0.05)). There were no significant differences in the overall complication rate, including infection, dislocation, re-fracture, and revision surgery, between the two groups.
CONCLUSIONS: Both surgical techniques, cementless long stem and cementless short taper stem with plate osteosynthesis, are effective in the treatment of Vancouver B2 PPFs, with no significant differences in outcomes or complications. However, patients in cementless short taper stem with plate osteosynthesis had better functional scores at both post-operative and the last follow-up.
摘要：
目的：髋关节周围的股骨假体周围骨折（PPFs）是骨科手术中具有挑战性的并发症，特别是温哥华B2型（VTB2）骨折。这些骨折的手术治疗至关重要，取决于各种因素。带板接骨术的无水泥短锥杆是一种替代的手术技术。这项研究旨在比较这种手术技术与长茎的翻修关节成形术（RA）治疗VTB2PPFs的结果。
方法：这项回顾性研究于2010年2月至2019年5月在一家医疗机构进行。包括接受全髋关节置换术或双极半髋关节置换术并随后发展为VTB2PPF的患者；术中骨折或先前接受骨水泥茎的患者被排除在分析之外。将患者分为两组：I组接受无骨水泥长茎RA，而II组接受无骨水泥短锥杆和钢板接骨术的RA。人口统计数据,放射学和功能结果，并对两组并发症进行分析。
结果：本研究共纳入85例诊断为VTB2PPFs的患者。两组在人口统计数据方面没有显着差异，包括年龄,性别,平均随访时间，估计失血量,和操作时间。X线检查结果显示，两组间沉降发生率和种植体稳定性无显著差异。然而,II组倾向于下沉和假体周围骨溶解较少。II组患者的功能评分明显更好（平均Harris髋关节评分：术后：I组60.2和II组66.7；最后一次随访：1组77.4和II组83.2（均p<0.05））。总并发症发生率无显著差异,包括感染,位错,再骨折,和翻修手术，两组之间。
结论：两种手术技术，无骨水泥长杆和无骨水泥短锥杆与钢板接骨术，对温哥华B2PPF的治疗有效，结果或并发症无显著差异。然而,无骨水泥短锥杆钢板接骨术患者在术后和末次随访时的功能评分均较好.
方法：这项回顾性研究于2010年2月至2019年5月在一家医疗机构进行。包括接受全髋关节置换术或双极半髋关节置换术并随后发展为VTB2PPF的患者；术中骨折或先前接受骨水泥茎的患者被排除在分析之外。将患者分为两组：I组接受无骨水泥长茎RA，而II组接受无骨水泥短锥杆和钢板接骨术的RA。人口统计数据,放射学和功能结果，并对两组并发症进行分析。
结果：本研究共纳入85例诊断为VTB2PPFs的患者。两组在人口统计数据方面没有显着差异，包括年龄,性别,平均随访时间，估计失血量,和操作时间。X线检查结果显示，两组间沉降发生率和种植体稳定性无显著差异。然而,II组倾向于下沉和假体周围骨溶解较少。II组患者的功能评分明显更好（平均Harris髋关节评分：术后：I组60.2和II组66.7；最后一次随访：1组77.4和II组83.2（均p<0.05））。总并发症发生率无显著差异,包括感染,位错,再骨折,和翻修手术，两组之间。
结论：两种手术技术，无骨水泥长杆和无骨水泥短锥杆与钢板接骨术，对温哥华B2PPF的治疗有效，结果或并发症无显著差异。然而,无骨水泥短锥杆钢板接骨术患者在术后和末次随访时的功能评分均较好.
