Ates D M, Koenen P, Otchwemah R, Bäthis H
Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Kliniken Stadt Köln gGmbH, Klinikum Köln-Merheim, Lehrstuhl, Universität Witten-Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
Orthopade. 2019 Apr;48(4):322-329. doi: 10.1007/s00132-019-03696-8.
Both increasing implantation numbers of total hip replacements and demographic change with higher populations of older people, indicate that there will be an increase in periprosthetic fractures in the future.
Falls in the home environment are the most common cause. Significant co-factors include reduced patient coordination, reduced bone quality, or implant-associated factors such as local osteolysis or pre-existing implant loosening.
In the classification of periprosthetic fractures of the femur, the Vancouver classification has prevailed in recent years, which in addition to a description of the localization of the fracture also considers the stability of the prosthesis and bone quality. Based on this, therapeutic algorithms have been developed that can vary from the conservative approach via osteosynthetic options to a replacement of the prosthesis. In order to allow the description of periprosthetic fractures on all joints, the Vancouver classification has been extended to the UCS classification by including the AO/OTA bone and joint coding system. In the selection of the treatment method, the consideration of individual patient factors such as activity level and secondary diagnoses is essential. Based on the established classifications, the importance of the different therapeutic methods is presented.
全髋关节置换植入数量的增加以及老年人口数量增多导致的人口结构变化，均表明未来假体周围骨折的数量将会增加。
家庭环境中的跌倒最为常见。重要的协同因素包括患者协调性下降、骨质降低，或诸如局部骨溶解或既往存在的假体松动等与植入物相关的因素。
在股骨假体周围骨折的分类中，温哥华分类近年来占据主导地位，该分类除了描述骨折的部位外，还考虑了假体的稳定性和骨质。基于此，已经制定了治疗算法，其范围可以从保守治疗方法到骨合成选择，再到假体置换。为了能够描述所有关节的假体周围骨折，温哥华分类通过纳入AO/OTA骨与关节编码系统扩展为UCS分类。在选择治疗方法时，考虑个体患者因素如活动水平和继发诊断至关重要。基于既定的分类，介绍了不同治疗方法的重要性。
