弗兰克·斯廷奇菲尔德奖：定制全髋关节置换假体周围骨折风险计算器的建立。
Frank Stinchfield Award: Creation of a Patient-Specific Total Hip Arthroplasty Periprosthetic Fracture Risk Calculator.
机构信息
Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota.
Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota; Mayo Clinic Department of Quantitative Health Sciences, Rochester, Minnesota.
出版信息
J Arthroplasty. 2023 Jul;38(7S):S2-S10. doi: 10.1016/j.arth.2023.03.031. Epub 2023 Mar 17.
BACKGROUND
Many risk factors have been described for periprosthetic femur fracture (PPFFx) following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions.
METHODS
We evaluated 16,696 primary nononcologic THAs performed between 1998 and 2018. During a mean 6-year follow-up, 558 patients (3.3%) sustained a PPFFx. Patients were characterized by individual natural language processing-assisted chart review on nonmodifiable factors (demographics, THA indication, and comorbidities), and modifiable operative decisions (femoral fixation [cemented/uncemented], surgical approach [direct anterior, lateral, and posterior], and implant type [collared/collarless]). Multivariable Cox regression models and nomograms were developed with PPFFx as a binary outcome at 90 days, 1 year, and 5 years, postoperatively.
RESULTS
Patient-specific PPFFx risk based on comorbid profile was wide-ranging from 0.4-18% at 90 days, 0.4%-20% at 1 year, and 0.5%-25% at 5 years. Among 18 evaluated patient factors, 7 were retained in multivariable analyses. The 4 significant nonmodifiable factors included the following: women (hazard ratio (HR) = 1.6), older age (HR = 1.2 per 10 years), diagnosis of osteoporosis or use of osteoporosis medications (HR = 1.7), and indication for surgery other than osteoarthritis (HR = 2.2 for fracture, HR = 1.8 for inflammatory arthritis, HR = 1.7 for osteonecrosis). The 3 modifiable surgical factors were included as follows: uncemented femoral fixation (HR = 2.5), collarless femoral implants (HR = 1.3), and surgical approach other than direct anterior (lateral HR = 2.9, posterior HR = 1.9).
CONCLUSION
This patient-specific PPFFx risk calculator demonstrated a wide-ranging risk based on comorbid profile and enables surgeons to quantify risk mitigation based on operative decisions.
LEVEL OF EVIDENCE
Level III, Prognostic.
背景
全髋关节置换术后发生股骨假体周围骨折（PPFFx）的风险因素有很多，但目前仍缺乏一种针对患者个体的风险评估工具。本研究旨在开发一种高维的、针对患者个体的风险分层列线图，以便根据手术决策进行动态风险修正。
方法
我们评估了 1998 年至 2018 年间进行的 16696 例非肿瘤性初次全髋关节置换术。在平均 6 年的随访期间，558 例患者（3.3%）发生了 PPFFx。通过使用自然语言处理辅助图表回顾的方法，对不可变因素（人口统计学、THA 适应证和合并症）和可修改的手术决策（股骨固定方式[骨水泥型/非骨水泥型]、手术入路[直接前路、外侧和后路]以及假体类型[带领/无领]）进行了患者特征描述。采用多变量 Cox 回归模型和列线图，以术后 90 天、1 年和 5 年时的 PPFFx 为二项结局进行分析。
结果
根据合并症谱，患者个体的 PPFFx 风险范围很广，术后 90 天为 0.4%-18%，1 年为 0.4%-20%，5 年为 0.5%-25%。在评估的 18 个患者因素中，有 7 个因素保留在多变量分析中。4 个显著的不可变因素包括：女性（风险比[HR] 为 1.6）、年龄较大（每增加 10 岁 HR 增加 1.2）、骨质疏松症诊断或使用骨质疏松症药物（HR 为 1.7）以及非骨关节炎手术适应证（骨折为 HR 为 2.2，炎性关节炎为 HR 为 1.8，股骨头坏死为 HR 为 1.7）。纳入的 3 个可修改的手术因素如下：非骨水泥型股骨固定（HR 为 2.5）、无领股骨假体（HR 为 1.3）和除直接前路以外的手术入路（外侧 HR 为 2.9，后侧 HR 为 1.9）。
结论
该患者特异性的 PPFFx 风险计算器基于合并症谱显示了广泛的风险范围，并使外科医生能够根据手术决策量化风险降低。
证据等级
III 级，预后。
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