Mortality after periprosthetic fracture of the femur
Mortality after periprosthetic fracture of the femur
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DOI：
10.2106/jbjs.f.01538
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发表时间：
2007-12-01
影响因子：
5.3
通讯作者：
Malchau, Henrik
中科院分区：
文献类型：
--
作者：
Bhattacharyya, Timothy;Chang, Denis;Malchau, Henrik
背景：股骨假体周围骨折的处理通常是复杂的，很少有研究记录其相关的死亡率。方法：我们回顾性地从我们的创伤和外科记录中找出106例接受假体周围股骨骨折手术的患者。然后，我们确定了309例髋部骨折（股骨颈或股骨粗隆间）患者和311例原发性髋关节或膝关节置换术患者的同期年龄和性别匹配的对照队列。使用社会保障数据库确定了一年的死亡率。结果：106例患者中有12例（11%）在假体周围骨折手术治疗后一年内死亡。在相同的随访期间，309例患者中有51例（16.5%）死于髋部骨折手术，311例患者中有9例（2.9%）死于原发性关节置换术。股骨假体周围骨折后的死亡率明显高于接受原发性关节置换术的匹配患者（p < 0.0001），与髋部骨折后的死亡率相似。对于假体周围骨折，从入院到手术时间延迟超过2天与1年死亡率增加相关（p < 0.0007）。49例患者接受了翻修性关节置换术治疗Vancouver型b型假体周围骨折，6例（12%）死亡。相比之下，24例温哥华b型假体周围骨折患者接受切开复位和内固定治疗，8例（33%）死亡。差异有统计学意义（p < 0.03）。结论：股骨假体周围骨折术后1年内死亡率高，与髋部骨折术后死亡率相似。由于翻修关节置换术治疗b型假体周围骨折的一年死亡率明显低于手术切开复位和内固定治疗后的死亡率，在两种治疗方案都可行的情况下，翻修关节置换术可能是首选。
Background: Management of periprosthetic femoral fractures is often complex, and few studies have documented its associated mortality.Methods: We retrospectively identified from our trauma and surgical registries 106 patients who underwent surgery for a periprosthetic femoral fracture. We then identified a contemporaneous age and sex-matched control cohort of 309 patients who had a hip fracture (femoral neck or intertrochanteric) and 311 patients who underwent primary hip or knee replacement. Mortality at one year was identified with use of the Social Security database.Results: Twelve (11%) of 106 patients died within one year following surgical treatment of a periprosthetic fracture. During the same follow-up period, fifty-one (16.5%) of 309 patients died following surgery for a hip fracture and nine (2.9%) of 311 patients died following primary joint replacement. The mortality rate after a periprosthetic femoral fracture was significantly higher (p < 0.0001) compared with that for matched patients who had undergone primary joint replacement, and it was similar to the mortality rate after a hip fracture. For periprosthetic fractures, a delay of greater than two days from admission to the time of surgery was associated with an increased mortality rate at one year (p < 0.0007). Forty-nine patients underwent revision arthroplasty for the treatment of a Vancouver type-B periprosthetic fracture, and six (12%) died. In contrast, twenty-four patients with a Vancouver type-B periprosthetic fracture were treated with open reduction and internal fixation and eight (33%) died. The difference was significant (p < 0.03).Conclusions: The mortality rate within one year following surgical treatment of periprosthetic femoral fractures is high and is similar to that after treatment for hip fractures. Because revision arthroplasty for the treatment of type-B periprosthetic fractures was associated with a one-year mortality rate that was significantly less than that after surgical treatment with open reduction and internal fixation, in instances when either treatment option is feasible, revision arthroplasty may be the preferred option.