Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2020 Jul-Aug;64(4):258-264. doi: 10.1016/j.recot.2020.03.001. Epub 2020 May 4.
Periprosthetic fractures after primary knee arthroplasty has great importance in our environment due to the increase in their incidence and to the challenge they pose to the surgeon. Multiple factors have been associated with its production. The objective of the study was to identify the risk factors that could influence the appearance of these fractures, which of them are all modifiable and generate a probability prediction model based on these factors.
Analytical, observational, retrospective, unpaired study of 38 cases of periprosthetic femoral knee fractures and 80 controls with knee prostheses. In total, 118 patients, 83 women and 35 men with a mean age of 72.49 years were included in the study. Sociodemographic data, medical history and drug consumption were collected, as well as those related to surgery. A univariate and bivariate analysis of the fracture determining factors was performed, using a logistic regression model to avoid confusion bias.
Of all the factors studied according to the logistic regression model, it was obtained that female sex (OR = 7.6), dementia (OR = 5), motor/parkinson's alteration (OR = 19.3) and femoral overcut Previous (OR = 8.6) were factors associated with the increased risk of this type of fractures.
This work allows us to conclude that there are risk factors such as female sex, dementia and parkinson's that increase the probability of periprosthetic fracture that are inherent to the patient and are not modifiable. However, there is any other totally modifiable that can be avoided by being demanding and thorough in the surgical technique, such as the anterior femoral overcut.
初次膝关节置换术后的假体周围骨折在我们的环境中非常重要,因为其发病率增加,对外科医生构成挑战。已经有多种因素与它的产生有关。本研究的目的是确定可能影响这些骨折发生的危险因素,确定它们中哪些是所有可改变的,并基于这些因素生成一个概率预测模型。
这是一项关于 38 例股骨膝关节假体周围骨折患者和 80 例膝关节假体对照患者的分析性、观察性、回顾性、非配对研究。共有 118 名患者,83 名女性和 35 名男性,平均年龄为 72.49 岁,纳入本研究。收集了社会人口统计学数据、病史和药物使用情况,以及与手术相关的数据。对骨折决定因素进行了单变量和双变量分析,使用逻辑回归模型以避免混淆偏倚。
根据逻辑回归模型,在所有研究的因素中,发现女性(OR=7.6)、痴呆(OR=5)、运动/帕金森病改变(OR=19.3)和股骨前侧过度截骨(OR=8.6)是与这种类型骨折风险增加相关的因素。
这项工作使我们能够得出结论,有一些风险因素,如女性、痴呆和帕金森病,会增加假体周围骨折的概率,这些因素是患者固有的,并且是不可改变的。然而,还有其他完全可以改变的因素,可以通过在手术技术上的严格要求和彻底性来避免,例如股骨前侧过度截骨。