Huang Jie-Feng, Jiang Xian-Jun, Shen Jian-Jian, Zhong Ying, Tong Pei-Jian, Fan Xiao-Hong
Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Orthopaedics, Affiliated Cixi Hospital of Wenzhou Medical College, Cixi, China.
J Orthop Sci. 2018 Nov;23(6):982-986. doi: 10.1016/j.jos.2018.07.014. Epub 2018 Aug 10.
The Unified Classification System (UCS) for Periprosthetic femoral fractures (PPFF) still has some limitations.
We retrieved 18 previous classifications for PPFF based on systematic review of the literature, and also retrospectively analyzed 402 cases with PPFF. 46 cases (11.4%) were identified as beyond the classification scope of the original UCS.
We modified the UCS as follows: (1) add two new B2 subtypes: B2PALT/B2PAGT (i.e., the pseudo ALT/AGT: Fracture in trochanter region including a segment of the proximal medial/lateral femoral cortex); (2) add a new FS category to encompass stem fracture alone or accompanied by PPFF, with FSO designating this fracture with stem fracture alone, FS1 designating this fracture with the proximal portion of the fractured femoral prosthesis being stable, FS2 designating this fracture with the proximal portion of the fractured femoral prosthesis being loose and the surrounding bone quality being good, and FS3 designating this fracture with the proximal portion of the fractured femoral prosthesis being loose and the bone bed being of poor quality; and (3) delete Type F which does not apply to the femur. Thus, using our modification of the UCS, among the 46 cases, we found thirty-five B2PALT, two B2PAGT, three FSO, one FS1, two FS2 and three SF3.
Compared to the original UCS, our modified version is more comprehensive. We believe it is useful to improve the judgment of the implant stability, and establish the therapeutic strategy for PPFF.
人工关节周围股骨骨折（PPFF）的统一分类系统（UCS）仍存在一些局限性。
我们通过对文献的系统回顾检索了先前的18种PPFF分类，并对402例PPFF病例进行了回顾性分析。46例（11.4%）被确定超出了原始UCS的分类范围。
我们对UCS进行了如下修改：（1）增加两个新的B2亚型：B2PALT/B2PAGT（即假性ALT/AGT：转子区骨折，包括股骨近端内侧/外侧皮质的一段）；（2）增加一个新的FS类别，以涵盖单独的假体柄骨折或伴有PPFF的情况，FSO表示仅假体柄骨折，FS1表示骨折的股骨假体近端稳定的这种骨折，FS2表示骨折的股骨假体近端松动且周围骨质良好的这种骨折，FS3表示骨折的股骨假体近端松动且骨床质量差的这种骨折；（3）删除不适用于股骨的F型。因此，使用我们修改后的UCS，在这46例病例中，我们发现35例B2PALT、2例B2PAGT、3例FSO、1例FS1、2例FS2和3例FS3。
与原始UCS相比，我们修改后的版本更全面。我们认为它有助于提高对植入物稳定性的判断，并为PPFF制定治疗策略。
