The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE-413 45 Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, R-huset, plan 4, Mölndals sjukhus, Göteborgsvägen 31, 431 80 Mölndal, Sweden.
The Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, SE-413 45 Gothenburg, Sweden; Lidköping Hospital, Sweden. Department of Orthopaedics, Mellbygatan 11-15, 531 85 Lidköping, Sweden.
Injury. 2019 Dec;50(12):2292-2300. doi: 10.1016/j.injury.2019.10.029. Epub 2019 Oct 15.
To investigate demographics and outcomes of Vancouver type C periprosthetic femoral fractures (PPFF) treated with open reduction and internal fixation.
Patient data were obtained from medical charts of cases reported to the Swedish Hip Arthroplasty Register and/or from the National Patient Register. Vancouver type C fractures undergoing surgery between 2001 and 2011, in patients who had received their primary THR between 1979 and 2011, were included. Any further reoperation performed between 2001 and 2013 and related to the PPFF constituted the primary outcome.
A total of 632 patients with 639 Vancouver type C fractures were identified. The majority of the patients were women (84%) and they had a fracture distal to a cemented stem (95%). The mean age at the time of fracture was 72 years. Treatment was performed with a locking plate (363 cases), a conventional plate (184 cases), an intramedullary nail (62 cases), or with double plating (30 cases). The overall reoperation rate was 17%, and mortality within one year of the operation was 16%. Locking plates had a significantly lower reoperation rate than conventional plates (p<0.001) and intramedullary nailing (p = 0.005). Interprosthetic femoral fractures did not have a statistically different outcome compared with non-IPFFs.
The lowest reoperation rate was observed using locking plates in Vancouver type C fractures when compared with conventional plates or intramedullary nailing. The presence of an ipsilateral knee prosthesis did not influence the outcome of the surgical treatment.
研究使用切开复位内固定治疗温哥华 C 型股骨假体周围骨折（PPFF）的患者的人口统计学特征和结局。
从瑞典髋关节置换登记处和/或国家患者登记处获得病例报告中的患者数据。纳入在 1979 年至 2011 年间接受初次 THR 且在 2001 年至 2011 年间接受手术治疗的温哥华 C 型骨折患者。任何在 2001 年至 2013 年间与 PPFF 相关的进一步手术被认为是主要结局。
共确定了 632 例 639 例温哥华 C 型骨折患者。大多数患者为女性（84%），骨折位于骨水泥固定柄的远端（95%）。骨折时的平均年龄为 72 岁。治疗方法为使用锁定板（363 例）、普通钢板（184 例）、髓内钉（62 例）或双钢板（30 例）。总的再次手术率为 17%，术后 1 年内的死亡率为 16%。与普通钢板（p<0.001）和髓内钉（p=0.005）相比，锁定板的再次手术率显著降低。假体间股骨骨折与非假体间股骨骨折相比，结果没有统计学差异。
与普通钢板或髓内钉相比，在温哥华 C 型骨折中使用锁定板可获得最低的再次手术率。同侧膝关节假体的存在并不影响手术治疗的结果。
