Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 Mar-Apr;64(2):92-98. doi: 10.1016/j.recot.2019.11.002. Epub 2020 Jan 31.
The incidence of periprosthetic fractures of the knee is increasing due to the increase in the number of total knee arthroplasties performed, together with population aging. We found few studies that analyze mortality in our setting after surgery. Our objective was to evaluate mortality and survival after surgical treatment of periprosthetic fractures of the distal femur in our environment.
We conducted a retrospective observational study of a consecutive series of 97 patients surgically treated in our centre for periprosthetic knee fracture between 2007-2015, with a minimum follow-up of 12months. Diverse sociodemographic, clinical and surgical variables were analyzed. A consultation was made to the National Death Index of the Ministry of Health for the analysis of mortality and survival was analyzed using the Kaplan-Meier method.
We reviewed a total of 97 patients with an average age of 75years, of which 86 were women and 11 were men. Of the patients, 50.5% of patients had some comorbidity. The average delay until the intervention was 3.1days. With respect to the treatment, 45 patients were operated by osteosynthesis with plate (49.5%), 40 with intramedullary nail (41.2%) and 9 with revision of the arthroplasty (9.3%). A total of 30 deaths were recorded during the follow-up, with cumulative mortality in the first year, at 3 and at 10 years of 7.2%, 17.5% and 30.9%, respectively, progressively increasing in people over 75years. There was no significant difference in mortality rates with the osteosynthesis method. The main complication was pseudoarthrosis (6.2%).
Periprosthetic knee fractures are associated with high rates of complications and mortality. The patient's age and the lesion itself are non-modifiable factors that can influence mortality after surgery, while other variables such as the type of intervention or surgical delay did not show differences in mortality rates in our study.
由于全膝关节置换术数量的增加以及人口老龄化，膝关节假体周围骨折的发病率正在增加。我们发现很少有研究分析我们环境下手术后的死亡率。我们的目的是评估我们环境中股骨远端假体周围骨折手术后的死亡率和生存率。
我们对 2007-2015 年在我们中心接受手术治疗的 97 例膝关节假体周围骨折连续患者进行了回顾性观察研究，随访时间至少为 12 个月。分析了各种社会人口统计学、临床和手术变量。向卫生部国家死亡指数进行了查询，以分析死亡率和生存情况，并使用 Kaplan-Meier 方法进行了分析。
我们共回顾了 97 例平均年龄为 75 岁的患者，其中 86 例为女性，11 例为男性。50.5%的患者有某种合并症。干预的平均延迟时间为 3.1 天。关于治疗，45 例患者接受钢板内固定（49.5%），40 例患者接受髓内钉（41.2%），9 例患者接受关节置换翻修（9.3%）。在随访期间共记录了 30 例死亡，第 1 年、第 3 年和第 10 年的累积死亡率分别为 7.2%、17.5%和 30.9%，75 岁以上人群的死亡率逐渐增加。内固定方法与死亡率无显著差异。主要并发症为假关节（6.2%）。
膝关节假体周围骨折与高并发症和死亡率相关。患者年龄和病变本身是影响手术后死亡率的不可改变因素，而干预类型或手术延迟等其他变量在我们的研究中并未显示出对死亡率的差异。
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