Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties
Evaluating risk factors following surgery for periprosthetic fractures around hip and knee arthroplasties
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DOI：
10.1007/s00402-018-3084-9
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发表时间：
2019-04-01
影响因子：
2.3
通讯作者：
Youssef, Bishoy
中科院分区：
文献类型：
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作者：
Orfanos, Georgios;Lim, Justin;Youssef, Bishoy
背景随着对关节成形术需求的增加，假体周围骨折的发生率也不可避免的增加。研究患者合并症及其如何影响结局的生存因素很少。本研究旨在确定损伤后生存和预先存在的comorbidity.MethodsA共144例患者接受手术治疗的髋关节或膝关节假体周围骨折从2008年1月至2017年8月在我们的主要创伤医院。平均受伤年龄为80.9岁（SD 9.9）。每例患者进行了基于病例的分析，以确定损伤的特点，手术参数和comorbidity.ResultsThe平均生存期为12.7个月（95%CI 8.4-17.1）。生存分析显示，年龄大于75岁（p=0.001），阿萨3级或以上（p=0.009 Breslow检验），CVA或TIA病史（p=0.038 Breslow检验），痴呆（p=0.002对数秩检验）、抑郁（p=0.013对数秩检验）和性别（p=0.041，Breslow检验）以及假体周围骨折后的生存率。受伤后第一年内的生存率被发现受到骨质疏松症（p=0.020）和痴呆症（p=0.002）的存在的影响。通过仔细的优化和手术计划，可以将手术风险降至最低。阿萨、年龄和合并症（痴呆、CVA或TIA、骨质疏松）与损伤后生存率显著相关。因此，建议谨慎选择手术治疗的患者。
BackgroundThe increasing demand for arthroplasty has resulted in an inevitable rise in the number of periprosthetic fractures around implants. Survival factors looking into patient's comorbidities and how they influence outcome are rare. This study aims to identify correlations between survival post-injury and pre-existing comorbidities.MethodsA total of 144 patients underwent operative treatment for either a hip or a knee periprosthetic fracture from January 2008 to August 2017 at our Major Trauma Hospital. The mean age at injury was 80.9years old (SD 9.9). Each patient had a case-based analysis to ascertain injury characteristics, operative parameters and comorbidities.ResultsThe mean survival was 12.7months (95% CI 8.4-17.1). Survival analysis showed a correlation between age more than 75years old (p=0.001), ASA grade of 3 or higher (p=0.009 Breslow's test), history of CVA or TIA (p=0.038 Breslow's test), dementia (p=0.002 log rank test), depression (p=0.013 log rank test) and gender (p=0.041, Breslow's test) and survival post-periprosthetic fracture. Survival within the first year following injury was found to be affected by the presence of osteoporosis (p=0.020) and dementia (p=0.002).ConclusionPeriprosthetic fractures are associated with a high mortality risk (34.7%). Operative risks can be minimised with careful optimisation and surgical planning. ASA, age and comorbidities (dementia, CVA or TIA, osteoporosis) have a significant correlation with survival post-injury. Hence, careful patient selection for operative treatment is advised.