| ObjectTo compare the clinical efficacy of biotype modular prosthesis and biotype long stem prosthesis in the treatment of Vancouver type B2 periprosthetic femoral fractures after total hip arthroplasty.MethodThis study was a retrospective study.From January 2013 to January 2020,patients with Vancouver type B2 periprosthetic femoral fractures who underwent revision total hip arthroplasty with modular prosthesis or long-stem prosthesis were collected in XX hospital.According to the inclusion and exclusion criteria,a total of 73 patients were included.There were 38 patients in the modular prosthesis group,including 18 males and 20 females.There were 35 patients in the long-stem prosthesis group,including 15 males and 20 females.The perioperative data such as age,BMI,operation time,intraoperative blood loss,VAS pain score at admission and discharge,total length of hospital stay were recorded.All patients were reexamined at the outpatient clinic regularly after operation,and the follow-up time and postoperative complications of all patients were recorded.The fracture healing time was recorded and the position of the prosthesis was judged according to the imaging results of the patients during follow-up.The integration of the prosthesis and the medullary cavity was judged according to the Engn standard.Harris score and PPMS score were used to evaluate the hip function of patients.SPSS26.0 software was used to compare the Harris score and PPMS score of the two groups before operation,1 year after operation,2 years after operation,3 years after operation and at the last follow-up.The Harris score and PPMS score before operation and at last follow-up were compared in the modular prosthesis group and long-stem prosthesis group.In this way,the clinical efficacy of two biotype prostheses in the treatment of Vancouver type B2 periprosthetic femoral fractures was evaluated.ResultThe mean follow-up time was 36.38±0.67 months in the modular prosthesis group and 36.54±0.61 months in the long-stem prosthesis group.All patients were successfully followed up and no one was lost to follow-up.There were 38 patients in the modular prosthesis group,including 18 males and 20 females,with an average age of 76.29±6.25 years and BMI of 24.00±2.61kg/m~2.There were 35 patients in the long-stem prosthesis group,including 15 males and 20 females,with an average age of 75.69±5.01 years and BMI of 23.33±1.78kg/m~2.There were no significant differences in age,BMI and gender composition ratio between the two groups(P>0.05).There was no significant difference in preoperative VAS score,preoperative Harris score and preoperative PPMS score between the two groups(P>0.05).The mean operation time of modular prosthesis group was 211.34±10.88min,while that of long-stem prosthesis group was 197.571±9.55min.The mean operation time of modular prosthesis group was longer than that of long-stem prosthesis group.The mean blood loss was 802.89±39.04mL in the modular group and 703.14±43.44mL in the long-stem group.The mean blood loss in the modular group was significantly higher than that in the long-stem group.There were significant differences in operation time and the blood loss between the two groups(P<0.05).There was no significant difference in the total length of hospital stay between the two groups(P>0.05).There was no significant difference in VAS score between the two groups at discharge(P>0.05).At first year after operation,the average Harris score was 77.72±2.34 in the modular prosthesis group and 73.74±2.18 in the long-stem prosthesis group.The Harris score of the modular prosthesis group was higher than that of the long-stem prosthesis group,and the difference was statistically significant(P<0.05).There was no significant difference in Harris score between the two groups at the second year after operation,the third year after operation and the last follow-up(P>0.05).The mean Harris score of the modular prosthesis group improved from 17.17±1.64 points preoperatively to 93.36±0.41 points at the last follow-up(P<0.05).The mean Harris hip score in the long-stem group improved from 16.96±1.92 preoperatively to 93.20±0.32 at the final follow-up(P<0.05).At first year after operation,the PPMS score was 5.71±0.46 in the modular prosthesis group and 5.29±0.45 in the long-stem prosthesis group.The PPMS score of the modular prosthesis group was higher than that of the long-stem prosthesis group,and the difference was statistically significant(P<0.05).There was no significant difference in PPMS score between the two groups at the second year after operation,the third year after operation and the last follow-up(P>0.05).The mean PPMS score of the modular prosthesis group increased from 0.95±0.77 points preoperatively to 8.95±0.23 points at the last follow-up(P<0.05).The mean PPMS score of the long-stem prosthesis group increased from 0.91±0.82 preoperatively to 8.83±0.38 at the last follow-up(P<0.05).According to the imaging results of postoperative follow-up,the prosthesis was in good position and bone healed in both groups after operation.There was no significant difference in fracture healing time between the two groups(P>0.05).The complications of the modular prosthesis group included 1 case of thigh pain and 1 case of deep venous thrombosis of the lower extremity.There were 1 case of prosthesis dislocation,3 cases of thigh pain,and 1 case of deep venous thrombosis of the lower extremity in the long-stem prosthesis group.There were no significant differences in the above complications between the two groups(P>0.05).ConclusionBoth groups of prostheses achieved good clinical results in the treatment of Vancouver type B2 periprosthetic femoral fractures.The operation time and intraoperative blood loss were less in the long-stem prosthesis group than in the modular prosthesis group,which may be due to the more complex procedure of installing the modular prosthesis.In the early postoperative period,the clinical efficacy of the modular prosthesis group was better than that of the long-stem prosthesis group.In the mid-term follow-up,the clinical efficacy of modular prosthesis group and long-stem prosthesis group was comparable.There was no postoperative death in the two groups,and the survival rate of the prosthesis was 100%.No adverse events such as secondary periprosthetic fracture,incision infection,prosthesis loosening,prosthesis subsidence,and leg length discrepancy occurred in the two groups.The long-term clinical efficacy of the two groups still needs further follow-up observation. |
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