Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
Department of Orthopedic Surgery, Jeonbuk National University Medical School, Jeonju, Korea.
Clin Orthop Surg. 2023 Feb;15(1):42-49. doi: 10.4055/cios22004. Epub 2022 Aug 9.
Management of periprosthetic femoral fractures (PFFs) is reportedly challenging. Different patterns of PFFs would occur based on whether stem fixation was primarily cemented or cementless and whether these patterns would be associated with clinical outcomes, such as subsidence, fracture union, and complications, after stem revision.
A retrospective comparative study was performed, involving 52 PFF patients treated with tapered fluted modular stems (TFMSs). In the 52 patients with Vancouver B2 or B3, including 21 cemented stems and 31 cementless stems, fracture patterns and bone stock were analyzed. Clinical outcomes after revision surgery using the TFMSs were compared between the two groups.
Transverse or short oblique type PFFs occurred around the cemented stem with loosening at the bone-cement interface. The Paprosky type III femoral deficiency and Vancouver type B3 fracture were observed more frequently in the cemented stem group. Otherwise, spiral fractures occurred more frequently in the cementless group ( < 0.001). Excessive subsidence of > 5 mm was observed more frequently in the cemented stem group ( < 0.001). The re-revision rates were higher in the cemented group than in the cementless group ( = 0.047).
In our study, it was found that the patterns of transverse or oblique PFFs were more frequently produced with cemented stems, while long spiral fractures were more frequent with cementless stems. Stem subsidence and reoperation related to complications were more common in patients with PFFs around cemented stems than those with PFFs around cementless stems.
据报道，股骨假体周围骨折（PFFs）的治疗具有挑战性。不同类型的 PFFs 可能发生于骨水泥型或非骨水泥型假体固定后，这些类型是否与临床结果相关，如沉降、骨折愈合和并发症，这取决于翻修后假体的位置。
回顾性比较研究，纳入 52 例使用锥形螺旋模块化干（TFMSs）治疗的 PFF 患者。在 52 例温哥华 B2 或 B3 型患者中，包括 21 例骨水泥型和 31 例非骨水泥型，分析骨折类型和骨量。比较两组患者使用 TFMS 翻修术后的临床结果。
松动的骨水泥界面周围的骨水泥型假体发生横形或短斜形 PFF。骨水泥型假体组中更常见 Paprosky Ⅲ型股骨缺损和温哥华 B3 型骨折。而非骨水泥型假体组中更常见螺旋形骨折（<0.001）。骨水泥型假体组中>5mm 的过度沉降更为常见（<0.001）。骨水泥型假体组的再次翻修率高于非骨水泥型假体组（=0.047）。
在我们的研究中，发现横形或斜形 PFF 更常见于骨水泥型假体，而长螺旋形骨折更常见于非骨水泥型假体。与非骨水泥型假体周围 PFF 相比，骨水泥型假体周围 PFF 患者的假体沉降和与并发症相关的再次手术更为常见。
