Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, South Korea.
PLoS One. 2019 Sep 19;14(9):e0221731. doi: 10.1371/journal.pone.0221731. eCollection 2019.
The present study aimed to investigate the prevalence and clinical consequences of occult intra-operative periprosthetic femoral fractures in total hip arthroplasty (THA). Between 2012 and 2017, a total of 113 primary THAs were enrolled. The mean age of the patients was 66.4 ± 7.6 years. We assessed occult intra-operative periprosthetic femoral fractures with the use of computed tomography (CT) and risk factors, including age, sex, body mass index, diagnosis, stem size, and radiographic parameters of proximal femoral geometry were analyzed. We also assessed the differences in thigh pain and stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. Occult intra-operative periprosthetic femoral fractures were found in 13 of 113 hips (11.5%). In 9/13 (69.2%) of occult fractures, fracture lines were started from the region below the tip of the lesser trochanter. Six periprosthetic femoral fractures (5.3%) were found during the operation. Out of the five hips that had detected femoral fractures around the lesser trochanter intra-operatively, four hips (80%) showed concurrent occult fractures on different levels. The female sex (P = .01) and canal filling ratio at 7 cm below the tip of the lesser trochanter (P = .01) were significantly different between the patients with and without occult periprosthetic femoral fracture. The sex was significantly associated with an increased risk in predicting an occult intra-operative periprosthetic femoral fracture (odds ratio of male, 0.25 compared with the female; 95% CI, 0.08-0.85; p = .02). There was a significant difference in the incidence of thigh pain between occult fracture group and non-occult fracture group (P < .05). There were no significant differences in stem subsidence and alignment between the patients with and without occult periprosthetic femoral fracture. All 13 cases of occult intra-operative periprosthetic femoral fractures were healed at the final follow-up. Occult periprosthetic femoral fractures are common during a long, trapezoidal, double-tapered cementless femoral stem fixation in primary THA, that CT scans are helpful to identify them, and that these fractures do not adversely affect the implant's survival if a rigid fixation of the implants has been achieved.
本研究旨在探讨全髋关节置换术（THA）中隐性术中股骨假体周围骨折的发生率和临床后果。2012 年至 2017 年，共纳入 113 例初次 THA。患者平均年龄为 66.4±7.6 岁。我们使用计算机断层扫描（CT）评估隐性术中股骨假体周围骨折，并分析了包括年龄、性别、体重指数、诊断、股骨柄大小和股骨近端几何形状的放射学参数等相关危险因素。我们还评估了有和无隐性股骨假体周围骨折患者的大腿疼痛和股骨柄下沉及对线的差异。113 髋中发现 13 髋（11.5%）存在隐性术中股骨假体周围骨折。在 13 例隐性骨折中，9 例（69.2%）骨折线始于小转子尖端下方区域。术中发现 6 例股骨假体周围骨折（5.3%）。在术中发现小转子周围股骨假体周围骨折的 5 髋中，有 4 髋（80%）在不同水平上同时存在隐性骨折。女性（P=.01）和小转子下 7cm 处髓腔填充率（P=.01）在有和无隐性股骨假体周围骨折的患者之间差异有统计学意义。性别与隐性术中股骨假体周围骨折的发生风险显著相关（男性的比值比为 0.25，女性为 0.25；95%可信区间，0.08-0.85；P=0.02）。隐性骨折组与非隐性骨折组大腿疼痛发生率差异有统计学意义（P<0.05）。隐性股骨假体周围骨折患者与无隐性股骨假体周围骨折患者的股骨柄下沉和对线差异无统计学意义。13 例隐性术中股骨假体周围骨折患者最终随访时均愈合。在初次 THA 中，长的梯形双锥形非骨水泥股骨柄固定时，隐性股骨假体周围骨折较为常见，CT 扫描有助于发现这些骨折，如果植入物获得了牢固固定，这些骨折不会对植入物的存活率产生不利影响。
