Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.
J Arthroplasty. 2019 Jul;34(7):1400-1411. doi: 10.1016/j.arth.2019.03.031. Epub 2019 Mar 19.
The collum femoris preserving (CFP) stem was a specially designed femoral neck preserving component. The incidence, classification, and risk factors for intraoperative periprosthetic femoral fractures with this special stem remain unclear.
This was a retrospective study. We analyzed the clinical and radiological data of all patients who underwent primary hip arthroplasty with a CFP stem in our hospital between January 2006 and November 2018. Demographic characteristics and radiological features were obtained from the medical records and the Picture Archiving and Communication System, respectively. The incidence, Vancouver classification, and risk factors for intraoperative periprosthetic femoral fractures were identified.
A total of 1633 hips were included. The incidence rate of periprosthetic femoral fractures in patients undergoing total hip arthroplasty with a CFP stem was 3.2%. According to the Vancouver classification, there were 24 patients (45.3%) with Vancouver type A fractures, 27 patients (50.9%) with Vancouver type B fractures, and 2 patients (3.8%) with Vancouver type C fractures. Five independent risk (protective) factors were found, including surgical history (odds ratio [OR] = 3.275, 95% confidence interval [CI] = 1.192-8.997), neck-shaft angle (OR = 1.104, 95% CI = 1.058-1.152), neck length preserved (OR = 0.913, 95% CI = 0.850-0.980), canal flare index (OR = 0.636, 95% CI = 0.413-0.980), and bone mineral density (OR = 0.083, 95% CI = 0.016-0.417).
The detailed characteristics of intraoperative periprosthetic femoral fractures in patients who received a CFP stem were identified in this study. Cracks of the femoral neck and fractures on the front side of the proximal femur were more common in patients with CFP stems. As a kind of a femoral neck preserving stem, the anatomical features (eg, neck-shaft angle, preserving length) of the remaining femoral neck might influence the incidence and characteristics of intraoperative periprosthetic femoral fractures in patients with CFP stems.
股骨颈保留（CFP）柄是一种专门设计的保留股骨颈的部件。使用这种特殊的柄时，术中假体周围股骨骨折的发生率、分类和危险因素尚不清楚。
这是一项回顾性研究。我们分析了 2006 年 1 月至 2018 年 11 月期间在我院行 CFP 柄初次髋关节置换术的所有患者的临床和影像学资料。分别从病历和影像归档与通信系统中获取人口统计学特征和影像学特征。确定术中假体周围股骨骨折的发生率、温哥华分类和危险因素。
共纳入 1633 髋。使用 CFP 柄行全髋关节置换术的患者中，假体周围股骨骨折的发生率为 3.2%。根据温哥华分类，24 例（45.3%）为温哥华 A 型骨折，27 例（50.9%）为温哥华 B 型骨折，2 例（3.8%）为温哥华 C 型骨折。发现 5 个独立的风险（保护）因素，包括手术史（比值比[OR] = 3.275，95%置信区间[CI] = 1.192-8.997）、颈干角（OR = 1.104，95%CI = 1.058-1.152）、颈长保留（OR = 0.913，95%CI = 0.850-0.980）、髓腔锉指数（OR = 0.636，95%CI = 0.413-0.980）和骨密度（OR = 0.083，95%CI = 0.016-0.417）。
本研究明确了使用 CFP 柄的患者术中假体周围股骨骨折的详细特征。CFP 柄患者更常见股骨颈骨折和股骨近端前侧骨折。作为一种保留股骨颈的柄，保留的股骨颈的解剖学特征（如颈干角、保留长度）可能会影响 CFP 柄患者术中假体周围股骨骨折的发生率和特征。
