Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
Injury. 2019 Jul;50 Suppl 2:S45-S51. doi: 10.1016/j.injury.2019.01.044. Epub 2019 Feb 2.
Periprosthetic femoral fractures (PFFs) following total hip arthroplasty are becoming more prevalent and management of these fractures is often demanding. The surgeon has to assess in detail implant loosening, bone loss and type of fracture. The aim of the study is to identify the suitability of a treatment algorithm, based on the Vancouver classification that takes into account the activity and comorbidity of each patient.
This study retrospectively assessed 38 patients who were surgically treated for a PFF around total hip arthroplasty between 2010 and 2014. All fractures were classified according to the Vancouver classification. There were 14 type B1, 8 type B2, 10 type B3 and 6 type C fractures. The data examined were age, sex, mechanism of injury, type of fracture, ASA score, type of surgery and complications. Radiographic evaluations were performed at 1, 3, 6 months and every 12 months thereafter. Clinical results were measured using the Merle-d'Aubigné-Postel score. Treatment options included an ORIF in 22 patients and a stem revision in 16 patients, with or without plates or supplemental cortical strut grafting when required.
The mean duration of follow-up was 3.1 years, mean age was 71.2 years and six patients (15.7%) died. Union was obtained in all patients in a mean of 16 weeks. Three patients required a surgical revision: one for stem loosening and two for re-fracture after a new fall. One patient had varus malunion of the femur. The mean postoperative Merle-d'Aubigné-Postel score was 13.2. Thirteen patients showed excellent results, 14 had a good result, three had a fair outcome and two had a poor result. Twenty patients returned to their baseline mobility status, while 12 patients had either a decline in their ambulatory status or a need for additional assistive devices.
PFF remains a serious complication of hip arthroplasty that is accompanied by high morbidity and mortality rates. This study shows how patients' comorbidities and functional demand can direct the proper treatment. This is a suitable algorithm for the treatment of PFF, which can provide satisfactory results in terms of pain and function.
全髋关节置换术后的股骨假体周围骨折（PFF）越来越常见，此类骨折的治疗往往具有挑战性。外科医生需要详细评估假体松动、骨丢失和骨折类型。本研究旨在根据温哥华分型制定一种治疗方案，该方案考虑到每位患者的活动度和合并症。
本研究回顾性评估了 2010 年至 2014 年间接受全髋关节置换术后股骨假体周围骨折手术治疗的 38 例患者。所有骨折均根据温哥华分型进行分类。其中 B1 型 14 例，B2 型 8 例，B3 型 10 例，C 型 6 例。评估的资料包括年龄、性别、损伤机制、骨折类型、ASA 评分、手术类型和并发症。术后 1、3、6 个月及之后每年进行影像学评估。采用 Merle-d'Aubigné-Postel 评分评估临床结果。治疗选择包括 22 例切开复位内固定和 16 例翻修术，必要时可采用钢板或补充皮质骨支撑移植物。
平均随访时间为 3.1 年，平均年龄为 71.2 岁，6 例（15.7%）患者死亡。所有患者平均 16 周获得愈合。3 例患者需要手术翻修：1 例为假体松动，2 例为新跌倒后再骨折。1 例患者股骨发生内翻畸形愈合。术后 Merle-d'Aubigné-Postel 评分平均为 13.2。13 例患者结果为优，14 例为良，3 例为可，2 例为差。20 例患者恢复到基线活动水平，12 例患者活动度下降或需要额外的辅助设备。
PFF 仍然是髋关节置换术的严重并发症，其发病率和死亡率较高。本研究表明，患者的合并症和功能需求可以指导正确的治疗方法。这是一种治疗 PFF 的合适方案，在疼痛和功能方面可获得满意的结果。
