Vancouver B3Type Periprosthetic Proximal Femur Fractures Treated With Greater Trochanter Reattachment Device And Cortical Strut Bone Allograft

ObjectiveTo review therapeutic effect of the Vancouver B3type periprosthetic proximal femur fractures treateding with greater trochanter reattachment device (GTR) and cortical strut bone graft in the revision of prosthesis of total hip arthroplasty. MethodsA total of26patients from January2006to January2011were selected, including5males and21females, aged55～79years, mean aged63.52years. All the cases were treated by Zimmer greater trochanter reattachment device (GTR), and Zimmer Wagner uncemented long stem. Comprehensive examination before operation, eliminate operation contraindication, patients were evaluated operation tolerance.According to the X-ray and CT were preoperative templating, select proper prosthesis and allogenous bone plate.Operating carefully, properly handle the femoral defect, according to the steps of placing prosthesis, greater trochanter plate and allograft of cortical bone plates. After taking effective measures to prevent deep vein thrombosis, and functional exercise moderately Harris score was developed before and after the operation. The VAS score for patients with postoperative weight-bearing limb pain were evaluated by numerical measurement; preoperative and postoperative limb shortening, assess the situation of limb restoration of limb length; Prosthesis stability was assessed using digital radiography.ResultsAll the patients were followed-up for averaged25months (12～35months) after operation. Every patient reached union, and there was no infection, loose, nonunion, malunion. The Harris score was (35.26±3.35) before operation, which was improved to (84.70±6.21), and the good-to-excellent rate was80.77%(excellent5cases, good16cases, average5cases). Patients with postoperative weight-bearing walking, the VAS score was0-3points, an average of1.82points. Preoperative limb shortening than contralateral (2.43±0.91) cm, compared with the contralateral limb shortening (0.90±0.75) cm, t test was performed on two groups of data, compared with the preoperative, postoperative limb shortening was statistically significant decreases in value (P<0.05). To the end of follow-up, stability of the prostheses, allograft bone plate good healing.The group had9patients with ipsilateral femoral localized pain, symptomatic treatment, symptoms improved obviously.ConclusionThe revision of prosthesis of total hip arthroplasty using greater trochanter reattachment device (GTR) and cortical strut bone graft of the Vancouver B3type periprosthetic proximal femur fractures owns advantages of easy surgical operation, less complications, high rate of fracture healing, good recovery of the hip function and satisfactory results in a short-term.