Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Jinji Lake Community Health Service Center of Suzhou Industrial Park, 215000, Jiangsu, China.
PLoS One. 2023 May 19;18(5):e0285789. doi: 10.1371/journal.pone.0285789. eCollection 2023.
Periprosthetic fractures (PPFs) is one of the major causes of failure of hip arthroplasty with cementless stem; however, studies on the incidence and risk factors of PPFs after cementless hemiarthroplasty for femoral neck fractures (FNFs) are lacking.
This retrospective study included patients who underwent cementless bipolar hemiarthroplasty for displaced intracapsular FNFs. The demographic data were reviewed, Dorr classification was used to describe morphology of the femur, radiological parameters were measured including stem-shaft angle, canal fill ratio (CFR), canal flare index (CFI), morphologic cortical index (MCI), canal calcar ratio (CCR), and vertical and horizontal femoral offset.
The sample comprised 10 men and 46 women (affected hip: left, 38; right, 18). The mean patient age was 82.82±10.61 (range, 69-93) years, and the mean hemiarthroplasty to PPFs time was 26.28±14.04 (range, 6.54-47.77) months. Seven (12.28%) patients had PPFs. A significant relationship was found between the incidence of PPF and CFR (p = 0.012), patients had a significantly smaller femoral stem CFR (0.76%±0.11%) than controls (0.85%±0.09%). The PPFs group had a significant shorter and unreestablished vertical femoral offset (p = 0.048).
A smaller femoral stem CFR associated with a potentially unacceptably high PPFs risk in uncemented hemiarthroplasty for displaced FNFs may result from mismatched prosthesis and bone dimensions in the elderly population, especially when accompanied by a poorly reestablished vertical femoral offset. With increasing evidence of the benefits of cemented fixation, a cemented stem for the treatment of displaced intracapsular FNFs is recommended for such a elderly frail population.
假体周围骨折（PPF）是骨水泥型非骨水泥股骨柄髋关节置换失败的主要原因之一；然而，对于股骨颈骨折（FNF）行骨水泥型半髋关节置换术后 PPF 的发生率和危险因素的研究尚缺乏。
本回顾性研究纳入了因移位的囊内 FNF 行骨水泥型双动半髋关节置换术的患者。回顾了患者的一般资料，采用 Dorr 分类描述股骨形态，测量了放射学参数，包括柄-干角、髓腔填充率（CFR）、髓腔扩张指数（CFI）、形态皮质指数（MCI）、髓腔距比（CCR）、垂直和水平股骨偏心距。
该样本包括 10 名男性和 46 名女性（患髋：左侧 38 例，右侧 18 例）。患者平均年龄为 82.82±10.61（范围 69-93）岁，半髋关节置换至 PPF 时间平均为 26.28±14.04（范围 6.54-47.77）个月。7 例（12.28%）患者发生 PPF。PF 发生率与 CFR 显著相关（p=0.012），患者的股骨柄 CFR 明显较小（0.76%±0.11%），对照组为 0.85%±0.09%。PF 组的垂直股骨偏心距显著缩短且未重建（p=0.048）。
对于移位的 FNF 行骨水泥型半髋关节置换术，较小的股骨柄 CFR 可能与假体和骨骼尺寸不匹配，导致潜在的不可接受的高 PPFs 风险，这在老年人群中更为明显，尤其是当垂直股骨偏心距重建不良时。随着骨水泥固定优势的证据不断增加，对于如此脆弱的老年人群，建议使用骨水泥型股骨柄治疗移位的囊内 FNF。
