【摘要】 目的 观察生物型股骨柄翻修联合钢丝环扎内固定治疗高龄Vancouver B2型股骨假体周围骨折的临床疗效。方法回顾性分析自2015-01—2022-12采用生物型股骨柄翻修联合钢丝环扎内固定治疗的24例高龄Vancouver B2型股骨假体周围骨折，切开复位骨折后选用双股直径1.0 mm医用不锈钢钢丝，在距骨折线远端2 cm处股骨干预制骨皮质凹槽防止钢丝滑移，以钢丝导引器实施张力带式环扎。首道钢丝置于股骨小粗隆下缘水平，后续两道钢丝间距1.5 cm向远端分布，拧紧时维持环扎张力，确保骨折端获得轴向加压，同时需要避免钢丝切割疏松骨质。髓腔准备时采用柔性铰刀系统逐级扩髓，直至髓腔直径较计划置入假体大2 mm。选择锥形槽设计的生物型翻修柄，其远端直径需超过末次扩髓钻1 mm以获初始稳定。假体长度需跨越最近端环扎钢丝至少5 cm，置入时保持10°～15°前倾角。结果 24例均获得随访，随访时间24～54个月，平均32个月。所有患者均未出现假体松动、环扎钢丝断裂、环扎钢丝切割骨质或再骨折情况，股骨柄假体骨折周围均有连续骨痂形成。影像学检查评估证实骨折愈合时间为12～22周，平均15.6周。22例获得假体-股骨长入性稳定，末次随访时Engh评分21～30分，平均25.6分。术后1年髋关节功能Harris评分为78～95分，平均86.2分；末次随访时Harris评分为76～93分，平均85.3分。结论 采用生物型股骨柄翻修联合钢丝环扎内固定治疗高龄Vancouver B2型股骨假体周围骨折可取得满意的中期疗效，骨折愈合良好，髋关节功能恢复满意。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of biologic femoral stem revision combined with cerclage wire fixation for Vancouver B2 periprosthetic femoral fractures in elderly patients.Methods A retrospective analysis was conducted of 24 elderly patients with Vancouver B2 periprosthetic femoral fractures treated with biologic femoral stem revision combined with cerclage wire fixation between January 2015 and December 2022. After open reduction of the fracture, double-stranded 1.0 mm medical stainless-steel wires were used. A cortical groove was created in the femoral shaft 2 cm distal to the fracture line to prevent wire slippage, and tension-band cerclage was applied using a wire passer. The first cerclage wire was placed at the level of the inferior border of the lesser trochanter, and the subsequent two wires were distributed distally at intervals of 1.5 cm. During tightening, appropriate cerclage tension was maintained to ensure axial compression at the fracture site while avoiding wire cutthrough in osteoporotic bone. Femoral canal preparation was performed with a flexible reaming system in a stepwise manner until the canal diameter was 2 mm larger than that of the planned implant. A tapered fluted biologic revision stem was selected,with the distal stem diameter being 1 mm larger than that of the final reamer to achieve initial stability. The stem length was required to bypass the most proximal cerclage wire by at least 5 cm, and anteversion was maintained at 10°-15° during implantation.Results All 24 patients completed follow-up for 24-54 months(mean, 32 months). No prosthetic loosening, cerclage wire breakage, wire cut-through, or refracture was observed in any patient, and continuous callus formation was noted around the fracture site in all cases. Radiographic evaluation confirmed fracture healing within 12-22 weeks, with a mean healing time of15.6 weeks. Osseointegrative stem–femur stability was achieved in 22 patients, and the Engh score at final follow-up ranged from 21 to 30 points, with a mean of 25.6 points. The Harris hip score ranged from 78 to 95 points at 1 year postoperatively(mean, 86.2 points) and from 76 to 93 points at final follow-up(mean, 85.3 points).Conclusion Biologic femoral stem revision combined with cerclage wire fixation can achieve satisfactory mid-term outcomes in elderly patients with Vancouver B2 periprosthetic femoral fractures, with reliable fracture healing, satisfactory recovery of hip function.更多还原