髋关节表面置换术后假体周围骨折的形态学分析。

Morphologic analysis of periprosthetic fractures after hip resurfacing arthroplasty.

机构信息

Departments of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

J Bone Joint Surg Am. 2010 Feb;92(2):404-10. doi: 10.2106/JBJS.H.01113.

DOI:10.2106/JBJS.H.01113

PMID:20124068

Abstract

BACKGROUND

Periprosthetic fractures have long been recognized as one of the major complications of hip resurfacing arthroplasty. The objective of this study was to develop a systematic and morphologic classification of the fracture mode based on pathogenesis.

METHODS

One hundred and seven retrieved specimens consisting of the femoral remnant and the femoral component of a total hip resurfacing arthroplasty that had failed as a result of a periprosthetic fracture were analyzed with regard to the morphologic failure mode. The location of the fracture line was used to differentiate the fractures. The fractures were also classified histopathologically as acute biomechanical, acute postnecrotic, or chronic biomechanical.

RESULTS

Fifty-nine percent (sixty-three) of the fractures occurred within the bone inside the femoral component. Fifty-one percent (fifty-five) of the fractures were classified morphologically as acute postnecrotic; 40% (forty-three), as chronic biomechanical; and 8% (nine), as acute biomechanical. Acute biomechanical fractures were found exclusively in the femoral neck and occurred earlier (mean time [and standard deviation] between implantation and revision, 41 +/- 57 days) than acute postnecrotic fractures (mean time between implantation and revision, 149 +/- 168 days; p = 0.002) or chronic biomechanical fractures (mean time between implantation and revision, 179 +/- 165 days; p = 0.001). The latter two fracture types both occurred predominantly in the bone inside the femoral component.

CONCLUSIONS

Three distinct fracture modes were characterized morphologically. Osteonecrosis was the most frequent cause of fracture-related failures. We suggest that an intraoperative mechanical injury of the femoral neck such as notching and/or malpositioning of the femoral component might lead to changes in the loading pattern or in the resistance to fracture of the femoral neck and may result in both acute and chronic biomechanical femoral neck fractures. These findings may serve as feedback information for the surgeon and possibly influence future therapeutic strategies.

摘要

背景

假体周围骨折一直被认为是髋关节表面置换术的主要并发症之一。本研究的目的是基于发病机制，对骨折模式进行系统的形态学分类。

方法

分析了 107 例因假体周围骨折而失效的全髋关节表面置换术的股骨残端和股骨部件的标本，分析了形态学失效模式。根据骨折线的位置来区分骨折。这些骨折还通过组织病理学分类为急性生物力学、急性坏死后或慢性生物力学。

结果

59%（63 例）的骨折发生在股骨部件内的骨内。51%（55 例）的骨折形态上被分类为急性坏死后；40%（43 例）为慢性生物力学；8%（9 例）为急性生物力学。急性生物力学骨折仅发生在股骨颈，发生较早（植入与翻修之间的平均时间[和标准差]为 41 +/- 57 天），而急性坏死后骨折（植入与翻修之间的平均时间为 149 +/- 168 天；p = 0.002）或慢性生物力学骨折（植入与翻修之间的平均时间为 179 +/- 165 天；p = 0.001）。后两种骨折类型都主要发生在股骨部件内的骨内。