Thompson N W, McAlinden M G, Breslin E, Crone M D, Kernohan W G, Beverland D E
Orthopaedic Outcomes Unit, Musgrave Park Hospital, Belfast, United Kingdom.
J Arthroplasty. 2001 Dec;16(8):984-90. doi: 10.1054/arth.2001.25563.
Periprosthetic fractures are a recognized complication of total knee arthroplasty. Fractures may occur intraoperatively or postoperatively, and risk factors have been identified that may predispose an individual to such a complication. We report 7 cases of periprosthetic tibial fractures after low contact stress total knee arthroplasty, a complication encountered by the senior author (D.E.B.) only after a change in practice from a cemented implant to a cementless one. In light of this previously unreported complication in our unit, we attempted to identify common features within this group of patients that may have contributed to fracture occurrence. Statistical analysis revealed a highly significant (P<.005) risk of periprosthetic tibial fracture in patients with a preoperative neutral or valgus knee. Age, gender, and diagnosis did not appear to increase the risk of fracture significantly. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual-energy x-ray absorptiometry scanning. Patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group, it may be preferable to have the tibial component inserted with cement fixation.
假体周围骨折是全膝关节置换术公认的并发症。骨折可发生在术中或术后，并且已经确定了可能使个体易患这种并发症的危险因素。我们报告了7例低接触应力全膝关节置换术后假体周围胫骨骨折的病例，资深作者（D.E.B.）仅在从骨水泥型假体改为非骨水泥型假体的实践改变后才遇到这种并发症。鉴于我们科室此前未报告过这种并发症，我们试图确定这组患者中可能导致骨折发生的共同特征。统计分析显示，术前膝关节为中立位或外翻位的患者发生假体周围胫骨骨折的风险非常高（P<0.005）。年龄、性别和诊断似乎并未显著增加骨折风险。所有患者在双能X线吸收法扫描中均显示腰椎和股骨颈区域骨密度降低。术前膝关节为中立位或外翻位且有局部骨质减少证据的患者属于高危人群，对此类患者应特别注意对线。在这组患者中，采用骨水泥固定插入胫骨假体可能更为合适。
