皮普金IV型股骨头骨折后全髋关节置换早期翻修的危险因素

Risk Factors for Early Conversion Total Hip Arthroplasty After Pipkin IV Femoral Head Fracture.

作者信息

Cichos Kyle H, White Parker A, Bergin Patrick F, Ghanem Elie S, McGwin Gerald, Hawkins Jacob, Spitler Clay A

机构信息

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.

Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS; and.

出版信息

J Orthop Trauma. 2023 Apr 1;37(4):181-188. doi: 10.1097/BOT.0000000000002512.

DOI:10.1097/BOT.0000000000002512

PMID:36730828

Abstract

OBJECTIVES

To determine risk factors for early conversion total hip arthroplasty (THA) in Pipkin IV femoral head fractures.

DESIGN

Retrospective cohort.

SETTING

Two level I trauma centers.

PATIENTS AND INTERVENTION

One hundred thirty-seven patients with Pipkin IV fractures meeting inclusion criteria with 1 year minimum follow-up managed from 2009 to 2019.

MAIN OUTCOME MEASUREMENT

Patients were separated into groups by the Orthopaedic Trauma Association/AO Foundation (OTA/AO) classification of femoral head fracture: 31C1 (split-type fractures) and 31C2 (depression-type fractures). Multivariable regression was performed after univariate analysis comparing patients requiring conversion THA with those who did not.

RESULTS

We identified 65 split-type fractures, 19 (29%) underwent conversion THA within 1 year. Surgical site infection ( P = 0.002), postoperative hip dislocation ( P < 0.0001), and older age ( P = 0.049) resulted in increased rates of conversion THA. However, multivariable analysis did not identify independent risk factors for conversion. There were 72 depression-type fractures, 20 (27.8%) underwent conversion THA within 1 year. Independent risk factors were increased age ( P = 0.01) and posterior femoral head fracture location ( P < 0.01), while infrafoveal femoral head fracture location ( P = 0.03) was protective against conversion THA.

CONCLUSION

Pipkin IV fractures managed operatively have high overall risk of conversion THA within 1 year (28.5%). Risk factors for conversion THA vary according to fracture subtype. Hip joint survival of fractures subclassified OTA/AO 31C1 likely depends on patient age and postoperative outcomes such as surgical site infection and redislocation. Pipkin IV fractures subclassified to OTA/AO 31C2 type with suprafoveal and posterior head impaction and older age should be counseled of high conversion risk with consideration for alternative management options.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定 Pipkin IV 型股骨头骨折早期全髋关节置换术（THA）转换的危险因素。

设计

回顾性队列研究。

地点

两个一级创伤中心。

患者与干预措施

137 例符合纳入标准的 Pipkin IV 型骨折患者，于 2009 年至 2019 年接受治疗，随访至少 1 年。

主要观察指标

根据骨科创伤协会/ AO 基金会（OTA/AO）股骨头骨折分类将患者分组：31C1（劈裂型骨折）和 31C2（塌陷型骨折）。在单因素分析后进行多变量回归，比较需要转换 THA 的患者与未转换的患者。

结果

我们确定了 65 例劈裂型骨折，其中 19 例（29%）在 1 年内进行了 THA 转换。手术部位感染（P = 0.002）、术后髋关节脱位（P < 0.0001）和年龄较大（P = 0.049）导致 THA 转换率增加。然而，多变量分析未确定转换的独立危险因素。有 72 例塌陷型骨折，20 例（27.8%）在 1 年内进行了 THA 转换。独立危险因素为年龄增加（P = 0.01）和股骨头后部骨折位置（P < 0.01），而股骨头骨折位于小凹下方（P = 0.03）可预防 THA 转换。

结论

手术治疗的 Pipkin IV 型骨折在 1 年内进行 THA 转换的总体风险较高（28.5%）。THA 转换的危险因素因骨折亚型而异。OTA/AO 31C1 亚类骨折的髋关节生存率可能取决于患者年龄以及手术部位感染和再脱位等术后结果。对于 OTA/AO 31C2 型、伴有小凹上方和后部股骨头撞击且年龄较大的 Pipkin IV 型骨折，应告知其转换风险高，并考虑替代治疗方案。