Risk factors for failure after treatment of a periprosthetic fracture of the femur
Risk factors for failure after treatment of a periprosthetic fracture of the femur
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DOI：
10.1302/0301-620x.88b1.17029
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发表时间：
2006-01-01
影响因子：
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通讯作者：
Garellick, G
中科院分区：
文献类型：
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作者：
Lindahl, H;Malchau, H;Garellick, G
股骨假体周围骨折是全髋关节置换术后不常见的并发症，但似乎正在增加。我们进行了一项全国性观察性研究，以确定这些骨折治疗后失败的危险因素，检查患者和植入物相关因素、骨折分类和结果。 1979 年至 2000 年间，瑞典国家髋关节置换术登记处报告了 1049 例股骨假体周围骨折。其中，245人在最初的管理失败后又进行了进一步的手术。数据是从登记册和医院记录中收集的。使用泊松回归模型对材料进行分析。结果发现，如果进行种植体翻修（p = 0.0033）或进行翻修和切开复位内固定（p = 0.0039），则温哥华 B2 型损伤治疗失败的风险会降低（p = 0.0053）。温哥华 B1 型骨折的失败风险显着较高 (p = 0.0001)。最强的负面因素是使用单板进行固定（p = 0.001）。该组中最常见的失败原因是股骨假体松动、骨不连和再骨折。许多被归类为温哥华 B1 型的骨折（n = 304）很可能实际上是 B2 型骨折，股骨假体松动但未被识别。在这些情况下，板固定不充分。区分 B1 型骨折和 B2 型骨折的困难表明，除非另有证明，否则应将假体视为松动。
Periprosthetic fracture of the femur is an uncommon complication after total hip replacement, but appears to be increasing. We undertook a nationwide observational study to determine the risk factors for failure after treatment of these fractures, examining patient- and implant-related factors, the classification of the fractures and the outcome.Between 1979 and 2000, 1049 periprosthetic fractures of the femur were reported to the Swedish National Hip Arthroplasty Register. Of these, 245 had a further operation after failure of their initial management. Data were collected from the Register and hospital records. The material was analysed by the use of Poisson regression models.It was found that the risk of failure of treatment was reduced for Vancouver type B2 injuries (p = 0.0053) if revision of the implant was undertaken (p = 0.0033) or revision and open reduction and internal fixation (p = 0.0039) were performed. Fractures classified as Vancouver type B1 had a significantly higher risk of failure (p = 0.0001). The strongest negative factor was the use of a single plate for fixation (p = 0.001). The most common reasons for failure in this group were loosening of the femoral prosthesis, nonunion and refracture.It is probable that many fractures classified as Vancouver type B1 (n = 304), were in reality type B2 fractures with a loose stem which were not recognised. Plate fixation was inadequate in these cases. The difficulty in separating type B1 from type B2 fractures suggests that the prosthesis should be considered as loose until proven otherwise.