Moreta Jesús, Aguirre Urko, de Ugarte Oskar Sáez, Jáuregui Iñaki, Mozos José Luis Martínez-De Los
Department of Orthopaedic Surgery and Traumatology, Hospital Galdakao-Usansolo, Bizkaia, Spain.
Research Unit, Hospital Galdakao-Usansolo, Bizkaia, Spain.
Injury. 2015 Feb;46(2):292-8. doi: 10.1016/j.injury.2014.07.013. Epub 2014 Jul 19.
The aim of this study was to determine the functional and radiological results of the treatment of periprosthetic femoral fractures.
A review was performed of all periprosthetic femur fractures after a total hip arthroplasty (THA) or hemiarthroplasty (HA) treated at our institution from 1995 to 2011. Functional outcome was assessed in terms of the Harris Hip Score and ambulatory status. Radiological findings were classified using Beals and Tower's criteria.
A total of 59 periprosthetic fractures were identified in 58 patients. The mean age of patients was 79 years old and the mean follow-up time was 33.6 months. Local risk factors were identified in 71% of the patients, principally osteoporosis (59%), followed by osteolysis (24%) and loosening of the stem (19%). In the multivariable analysis, the presence of local risk factors was associated with worsening of patients' ambulatory status. According to the Vancouver classification, there were 8 type A, 46 type B and 5 type C fractures. Of the type B fractures 24 were B1, 14 were B2 and 8 were B3. Fracture union was achieved in 54 fractures, with a mean union time of 6 months. Applying Beals and Tower's criteria, radiological results were excellent in 20 patients (34%), good in 22 (37%), and poor in 17 (29%). None of the patients improved their ability to walk after these fractures and 31 patients (52%) did not regain their prefracture walking status. The mean Harris Hip Score postoperatively was 67.9. There were major or minor complications in 33 patients (56%) and 11 patients (19%) required further operations.
Although this study shows good radiological results following methods of treatment in accordance with the Vancouver classification, there was marked functional deterioration in many patients and a high rate of complications. Local risk factors were associated with poorer ambulatory status.
本研究的目的是确定人工关节周围股骨骨折治疗后的功能和影像学结果。
对1995年至2011年在我院接受全髋关节置换术（THA）或半髋关节置换术（HA）后发生的所有人工关节周围股骨骨折进行回顾性研究。根据Harris髋关节评分和步行状态评估功能结果。使用Beals和Tower标准对影像学结果进行分类。
共58例患者发生了59例人工关节周围骨折。患者的平均年龄为79岁，平均随访时间为33.6个月。71%的患者存在局部危险因素，主要为骨质疏松（59%），其次为骨溶解（24%）和假体柄松动（19%）。在多变量分析中，局部危险因素的存在与患者步行状态的恶化相关。根据温哥华分类，有8例A型骨折、46例B型骨折和5例C型骨折。B型骨折中，24例为B1型，14例为B2型，8例为B3型。54例骨折实现了愈合，平均愈合时间为6个月。应用Beals和Tower标准，20例患者（34%）的影像学结果为优，22例（37%）为良，17例（29%）为差。这些骨折后，没有患者改善了行走能力，31例患者（52%）未恢复到骨折前的行走状态。术后Harris髋关节评分的平均值为67.9。33例患者（56%）发生了严重或轻微并发症，11例患者（19%）需要进一步手术。
尽管本研究显示按照温哥华分类法进行治疗后影像学结果良好，但许多患者出现了明显的功能恶化且并发症发生率较高。局部危险因素与较差的步行状态相关。
