Jain Amit, Erkula Gurkan, Leet Arabella I, Ain Michael C, Sponseller Paul D
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.
J Pediatr Orthop. 2012 Jul-Aug;32(5):547-52. doi: 10.1097/BPO.0b013e318259fe75.
To our knowledge, there are no comprehensive clinical studies of implant-related fractures in children. Our goal was to identify the incidence, skeletal location, and associated diagnoses of implant-related fractures.
We reviewed our institutional database to identify cases of implant insertion (7584 cases) in patients less than 18 years old from January 1, 1995 through December 31, 2009. We calculated the overall incidence of these fractures and stratified the incidence by skeletal location and preoperative diagnoses. Fisher exact test was used to ascertain differences in fracture incidence. Risk ratios were calculated when appropriate. Significance was set at P<0.05.
There were 25 cases of implant-related fractures: 22 in the femur, 2 in the tibia, and 1 in the radius. The overall incidence of implant-related fracture was 0.33%; the incidence by skeletal location was: femur, 0.89%; tibia, 0.1%; and radius, 0.14%. Associated diagnoses were cerebral palsy (9 cases), hip dysplasia (3 cases), spina bifida (2 cases), and avascular necrosis (1 case); 10 cases were associated with "other diagnoses," which included various skeletal syndromes (5 cases) and traumatic fractures (5 cases). The incidences of implant-related fractures by diagnoses were: cerebral palsy, 1.1%; hip dysplasia, 1.1%; spina bifida, 1.3%; and avascular necrosis, 0.35%. The incidence of implant-related fracture in the "other diagnoses" group was 0.16%, and the incidence of fracture in otherwise healthy patients was 0.084%. The femur was 15.2 times more likely to fracture than other bones (P<0.001). Diagnoses of cerebral palsy, hip dysplasia, spina bifida, and avascular necrosis were 6.1 times more likely to be associated with implant-related fractures than the "other diagnoses" (P<0.001). The mean time to fracture in the study was 2.8 years. The overall implant removal rate at our institution was 24.3%, and it varied significantly by patient diagnosis (P<0.01).
Skeletal location and preoperative diagnosis should be factors of consideration in a surgeon's decision about removing implants to prevent implant-related fractures.
Prognostic Level III.
据我们所知，目前尚无关于儿童植入物相关骨折的全面临床研究。我们的目标是确定植入物相关骨折的发生率、骨骼部位及相关诊断。
我们回顾了机构数据库，以确定1995年1月1日至2009年12月31日期间18岁以下患者的植入物植入病例（7584例）。我们计算了这些骨折的总体发生率，并按骨骼部位和术前诊断对发生率进行分层。采用Fisher精确检验确定骨折发生率的差异。在适当情况下计算风险比。显著性设定为P<0.05。
共有25例植入物相关骨折：22例发生在股骨，2例在胫骨，1例在桡骨。植入物相关骨折的总体发生率为0.33%；按骨骼部位的发生率分别为：股骨0.89%；胫骨0.1%；桡骨0.14%。相关诊断包括脑瘫（9例）、髋关节发育不良（3例）、脊柱裂（2例）和缺血性坏死（1例）；10例与“其他诊断”相关，其中包括各种骨骼综合征（5例）和创伤性骨折（5例）。按诊断分类的植入物相关骨折发生率分别为：脑瘫1.1%；髋关节发育不良1.1%；脊柱裂1.3%；缺血性坏死0.35%。“其他诊断”组中植入物相关骨折的发生率为0.16%，而其他健康患者的骨折发生率为0.084%。股骨骨折的可能性是其他骨骼的15.2倍（P<0.001）。脑瘫、髋关节发育不良、脊柱裂和缺血性坏死的诊断与植入物相关骨折相关的可能性是“其他诊断”的6.1倍（P<0.001）。研究中骨折的平均时间为2.8年。我们机构的总体植入物取出率为24.3%，且因患者诊断不同而有显著差异（P<0.01）。
骨骼部位和术前诊断应是外科医生决定取出植入物以预防植入物相关骨折时考虑的因素。
预后III级。
