假体周围非典型股骨骨折确实存在：单中心回顾性研究。115 例初次髋关节假体周围股骨骨折的发生率。

Periprosthetic Atypical Femoral Fractures Exist: A Retrospective Study at a Single Institution. Prevalence on 115 Periprosthetic Femoral Fractures Around a Primary Hip Stem.

机构信息

Department of Medicine Surgery and Neurosciences, The Section of Orthopedics, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.

Department of Oncology, The Section of Orthopedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.

出版信息

J Arthroplasty. 2021 Jun;36(6):2189-2196. doi: 10.1016/j.arth.2021.01.066. Epub 2021 Jan 30.

DOI:10.1016/j.arth.2021.01.066

PMID:33610412

Abstract

BACKGROUND

Some periprosthetic femoral fractures (PFFs) present history and radiographic aspect consistent with an atypical femoral fracture (AFF), fulfilling the criteria for AFF except that PFFs by themselves are excluded from the diagnosis of AFFs. The aim of this study is to evaluate in a single institution series of PFFs if any of them could be considered a periprosthetic atypical femoral fracture (PAFF), and their prevalence.

METHODS

Surgical records were searched for PFFs around a primary hip stem from January 2013 to December 2019. Cases were classified according to Vancouver classification. Demographic and medical history was extracted. Fisher's exact test was used for statistical analysis.

RESULTS

One hundred fifteen PFFs were identified, 59 of them were type B1 and 16 were type C. Radiographs and medical records were available for all patients. Twenty-four patients (32%) have been treated with bisphosphonates (BPs) for longer than 4 years. Four patients presented a fracture with characteristics of PAFF. When enlarged to all PFFs of the series, no other PAFF was found: prevalence of PAFFs was 5.3% for type B1 and C cases and 3.5% for all surgically treated PFFs. Statistical significative difference between PAFFs and PFFs was found for prolonged BP assumption and for the level of fracture clear of the stem.

CONCLUSION

Fracture with characteristics of AFFs can also happen over a prosthetic stem, configuring themselves as PAFFs, and they are related to prolonged BP use. As a correct diagnosis is mandatory for proper treatment, a revision of criteria for AFFs should be considered, accepting that PAFFs exist.

摘要

背景

一些股骨假体周围骨折（PFFs）具有与非典型股骨骨折（AFF）一致的病史和影像学表现，除了 PFFs 本身被排除在 AFF 诊断之外，符合 AFF 的所有标准。本研究旨在评估一家机构中 PFFs 的系列病例，以确定其中是否有任何病例可被认为是假体周围非典型股骨骨折（PAFF），并评估其患病率。

方法

从 2013 年 1 月至 2019 年 12 月，对初次髋关节假体周围的 PFFs 手术记录进行了检索。病例根据温哥华分类进行分类。提取了人口统计学和病史资料。Fisher 确切检验用于统计分析。

结果

共发现 115 例 PFFs，其中 59 例为 B1 型，16 例为 C 型。所有患者均有 X 线片和病历资料。24 例（32%）患者长期（>4 年）接受双膦酸盐（BPs）治疗。4 例患者出现具有 PAFF 特征的骨折。当扩大到整个系列的所有 PFFs 时，未发现其他 PAFF：B1 型和 C 型的 PAFF 患病率为 5.3%，所有手术治疗的 PFF 患病率为 3.5%。PAFFs 和 PFFs 之间在 BPs 假设时间延长和骨折远离假体的程度方面存在统计学显著差异。