Matharu Gulraj S, Pynsent Paul B, Dunlop David J, Revell Matthew P
Royal Orthopaedic Hospital, Birmingham, UK.
Hip Int. 2012 Sep-Oct;22(5):494-9. doi: 10.5301/HIP.2012.9760.
Complications following surgical intervention for periprosthetic hip fractures are not uncommon. We report the clinical outcome following definitive surgical intervention for this indication at a single tertiary referral centre. All patients admitted between 2003 and 2009 undergoing such treatment were included. Patient demographics, all surgical interventions, complications following definitive fracture treatment, and postoperative mortality were recorded. Radiographs were reviewed to determine the Vancouver classification for each fracture. There were 67 patients (mean age at revision 76.7 years; 61% female). Fractures occurred around primary total hip arthroplasties (43%), revision arthroplasties (34%), and hip hemiarthroplasties (23%). Mean time to fracture from the most recent arthroplasty performed was 7.0 years. Most fractures were Vancouver type B2 (49%). The majority of patients underwent revision total hip arthroplasty (96%), using long-stemmed prostheses or proximal femoral endoprostheses, with cables for fracture fixation. Wound infection and systemic complications were seen in 16% and 13% respectively. One or more further surgical interventions were performed in 12%. There were no deaths in-hospital or at 30-days, with 10 fatalities (15%) at a mean 2-year follow-up. Lower rates of re-intervention and mortality were observed when surgery for acute periprosthetic hip fractures was performed at a tertiary centre. Revision hip arthroplasty with or without fracture fixation proved an effective and safe treatment of periprosthetic hip fractures in a high-risk patient population.
人工髋关节周围骨折手术干预后的并发症并不少见。我们报告了在一家单一的三级转诊中心针对该适应症进行确定性手术干预后的临床结果。纳入了2003年至2009年间所有接受此类治疗的患者。记录了患者人口统计学资料、所有手术干预措施、确定性骨折治疗后的并发症以及术后死亡率。复查X线片以确定每个骨折的温哥华分类。共有67例患者（翻修时平均年龄76.7岁；61%为女性）。骨折发生在初次全髋关节置换术后（43%）、翻修关节置换术后（34%）和髋关节半关节置换术后（23%）。从最近一次进行的关节置换术到发生骨折的平均时间为7.0年。大多数骨折为温哥华B2型（49%）。大多数患者接受了翻修全髋关节置换术（96%），使用长柄假体或股骨近端假体，并使用缆线进行骨折固定。伤口感染和全身并发症的发生率分别为16%和13%。12%的患者进行了一次或多次进一步的手术干预。住院期间或30天内无死亡病例，平均2年随访时有10例死亡（15%）。在三级中心进行急性人工髋关节周围骨折手术时，再次干预和死亡率较低。带或不带骨折固定的翻修髋关节置换术被证明是一种在高危患者人群中治疗人工髋关节周围骨折的有效且安全的方法。
