Meek R M Dominic, Garbuz Donald S, Masri Bassam A, Greidanus Nelson V, Duncan Clive P
Southern General Hospital, 1345 Govan Road, Glasgow, Scotland.
J Bone Joint Surg Am. 2004 Mar;86(3):480-5. doi: 10.2106/00004623-200403000-00004.
In revision total hip arthroplasty, intraoperative split fractures and cortical perforation fractures are becoming a more common concern with the increasing use of diaphyseal fitting cementless stems. The purpose of this study was to evaluate the risk factors and frequency of intraoperative fractures with the use of these stems and their effect on radiographic and functional outcomes.
We performed a retrospective case-control study of 211 consecutive patients who had undergone revision hip arthroplasty with a diaphyseal fitting cementless stem between December 1998 and March 2002. Sixty-four patients sustained an intraoperative fracture of the femur. One hundred and fifteen patients were followed for a minimum of two years; function was analyzed with self-administered outcome questionnaires, and radiographs were evaluated for evidence of bone ingrowth into the femoral stem.
Risk factors associated with an intraoperative fracture were a substantial degree of preoperative bone loss, a low femoral cortex-to-canal ratio, underreaming of the cortex, and the use of a large-diameter stem. The majority of the diaphyseal undisplaced linear fractures occurred at the distal end of an extended trochanteric osteotomy during stem insertion. Fracture due to cortical perforation occurred most often during cement removal. These intraoperative fractures had no significant effect on the functional outcome or radiographic evidence of bone ingrowth.
There was a surprisingly high rate of intraoperative femoral fractures associated with the use of a diaphyseal fitting stem in revision total hip arthroplasty. Identification of risk factors such as preoperative bone loss and a low cortex-to-canal ratio may permit planning to avoid such fractures. However, the final functional and radiographic outcomes appear to have been unaffected by the fracture when it had been managed appropriately.
Prognostic study, Level II-1 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
在翻修全髋关节置换术中，随着骨干适配型非骨水泥柄的使用越来越多，术中劈裂骨折和皮质穿孔骨折正成为一个更常见的问题。本研究的目的是评估使用这些柄时术中骨折的危险因素和发生率，以及它们对影像学和功能结果的影响。
我们对1998年12月至2002年3月期间连续接受翻修髋关节置换术并使用骨干适配型非骨水泥柄的211例患者进行了一项回顾性病例对照研究。64例患者发生了术中股骨骨折。115例患者至少随访了两年；使用自我填写的结果问卷分析功能，并评估X线片以确定股骨柄骨长入的证据。
与术中骨折相关的危险因素包括术前大量骨质流失、股骨皮质与髓腔比例低、皮质扩髓不足以及使用大直径柄。大多数骨干无移位线性骨折发生在柄插入过程中延长转子截骨术的远端。皮质穿孔导致的骨折最常发生在取出骨水泥期间。这些术中骨折对功能结果或骨长入的影像学证据没有显著影响。
在翻修全髋关节置换术中，使用骨干适配型柄时术中股骨骨折的发生率惊人地高。识别术前骨质流失和皮质与髓腔比例低等危险因素可能有助于规划以避免此类骨折。然而，当骨折得到适当处理时，最终的功能和影像学结果似乎并未受到影响。
预后研究，II-１级（回顾性队列研究）。有关证据水平的完整描述，请参阅作者须知。
