Marr Nathalie, Müller Franz, Füchtmeier Bernd, Weber Markus, Eckstein Christoph, Wulbrand Christian
Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
Orthopadie (Heidelb). 2023 Nov;52(11):916-923. doi: 10.1007/s00132-023-04416-z. Epub 2023 Aug 9.
Interprosthetic femur fractures (IFF) are rare injuries, whose surgical treatment is basically with osteosynthesis or revision arthroplasty. Various therapy algorithms have been proposed based on very small study collectives. Factors influencing the outcome are not known.
The aim of the retrospective monocentric study is to derive a treatment algorithm based on a large number of cases and to identify factors influencing the outcome.
Between 2006 and 2020, 70 IFF were identified. The surgical treatment comprised 38 osteosyntheses, 30 revision arthroplasties and 2 amputations. With classification and time to surgery, 69 perioperative variables were recorded. General and operative complications, as well as mortality, were determined in the follow-up period of 1 year.
ASA and Charlson score correlated with 1‑year-mortality. In addition, preoperatively increased CRP levels, reduced hemoglobin and the CHADS-VASc score were identified as factors influencing mortality. Surgery within 24 h showed a trend towards fewer general complications. Transferred patients indicated an increased mortality. Based on classification according to Pires et al. or Füchtmeier et al. no clear treatment decision could be made. Relevant criteria for the surgical treatment were fracture localization, implant stability, bone vitality, anchoring possibility of the revision stem, as well as general condition of the patient.
The identified factors influencing the outcome correspond to those of patients with hip fractures. IFF should be treated timely. A treatment path was developed on the basis of the largest patient group to date.
人工关节置换术后股骨骨折（IFF）是一种罕见的损伤，其手术治疗主要采用骨固定或翻修关节成形术。基于非常小的研究样本已提出了各种治疗方案。但影响治疗结果的因素尚不清楚。
这项回顾性单中心研究的目的是基于大量病例得出一种治疗方案，并确定影响治疗结果的因素。
2006年至2020年期间，共确诊70例IFF。手术治疗包括38例骨固定、30例翻修关节成形术和2例截肢术。记录了69项围手术期变量，包括分类和手术时间。在1年的随访期内确定了全身和手术并发症以及死亡率。
美国麻醉医师协会（ASA）分级和查尔森评分与1年死亡率相关。此外，术前升高的CRP水平、降低的血红蛋白和CHADS-VASc评分被确定为影响死亡率的因素。24小时内进行手术显示全身并发症有减少的趋势。转院患者死亡率增加。根据皮雷斯等人或富希特迈尔等人的分类，无法做出明确的治疗决策。手术治疗的相关标准包括骨折部位、植入物稳定性、骨活力、翻修柄的锚固可能性以及患者的一般状况。
确定的影响治疗结果的因素与髋部骨折患者的因素一致。IFF应及时治疗。基于迄今为止最大的患者群体制定了一条治疗路径。
