Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Department of Joint Surgery, No.6 Hospital of Ningbo, Zhejiang, China.
J Arthroplasty. 2024 Oct;39(10):2547-2554. doi: 10.1016/j.arth.2024.06.005. Epub 2024 Jun 6.
The present study aimed to identify the risk factors of periprosthetic femoral fracture (PFF) after cementless total hip arthroplasty and rank them based on importance.
The age, sex, body mass index (BMI), osteoporosis, canal flare index (CFI), canal bone ratio (CBR), canal calcar ratio (CCR), stem design, and stem canal fill ratio (P1, P2, P3, and P4) of the proximal femoral medullary cavity of 111 total hip arthroplasty patients who had PFF and 388 who did not have PFF were analyzed. Independent-samples student t-tests were used for continuous variables, and Chi-square tests were used for categorical variables. The importance rankings of influencing factors were assessed using a random forest algorithm. Dimensionally reduced variables were then incorporated into a binary logistic regression model to determine the PFF-related risk factors.
The mean age, BMI, CBR, CCR, and incidence of osteoporosis were higher in cases of PFF (all P < .001), while the mean CFI, P1, P2, P3, and P4 were lower in cases of PFF (P < .001, P = .033, P = .008, P < .001, and P < .001, respectively). Additionally, the stem design was also statistically associated with PFF (P < .001). Multivariate logistic regression revealed that advanced age, higher BMI, osteoporosis, stem design, lower CFI, higher CBR, higher CCR, lower P1, lower P2, lower P3, and lower P4 were the risk factors of PFF (P < .001, P < .001, P < .001, P < .001, P < .001, P = .010, P < .001, P = .002, P < .001, P < .001, and P = .007, respectively). The ranked importance of the risk factors for PFF was P3, CFI, osteoporosis, CBR, age, P4, P1, stem design, CCR, BMI, and P2.
Lower P3, lower CFI, osteoporosis, higher CBR, advanced age, lower P4, lower P1, stem design, higher CCR, higher BMI, and lower P2 increased the risk of PFF.
本研究旨在确定非骨水泥全髋关节置换术后股骨假体周围骨折（PFF）的风险因素，并根据其重要性对其进行排序。
分析了 111 例 PFF 患者和 388 例无 PFF 患者的年龄、性别、体重指数（BMI）、骨质疏松症、髓腔管扩张指数（CFI）、髓腔骨比（CBR）、髓腔骨距比（CCR）、股骨近端髓腔干设计以及干腔填充比（P1、P2、P3 和 P4）。连续变量采用独立样本 t 检验，分类变量采用卡方检验。采用随机森林算法对影响因素进行重要性排序。然后将降维变量纳入二元逻辑回归模型，以确定与 PFF 相关的风险因素。
PFF 组的平均年龄、BMI、CBR、CCR 和骨质疏松症发生率较高（均 P<0.001），而 PFF 组的平均 CFI、P1、P2、P3 和 P4 较低（P<0.001，P=0.033，P=0.008，P<0.001，P<0.001）。此外，股骨近端髓腔干设计也与 PFF 有统计学关联（P<0.001）。多变量逻辑回归显示，年龄较大、BMI 较高、骨质疏松症、干设计、较低 CFI、较高 CBR、较高 CCR、较低 P1、较低 P2、较低 P3 和较低 P4 是 PFF 的危险因素（P<0.001，P<0.001，P<0.001，P<0.001，P<0.001，P=0.010，P<0.001，P=0.002，P<0.001，P<0.001，P=0.007，分别）。PFF 的风险因素重要性排序为 P3、CFI、骨质疏松症、CBR、年龄、P4、P1、干设计、CCR、BMI 和 P2。
较低的 P3、较低的 CFI、骨质疏松症、较高的 CBR、年龄较大、较低的 P4、较低的 P1、干设计、较高的 CCR、较高的 BMI 和较低的 P2 增加了 PFF 的风险。
