Yao Zhi-Yuan, Fan Shu-Yao, Zhao Wei-Qiang, Huang Jie-Feng
Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Orthop Surg. 2024 Aug;16(8):1816-1831. doi: 10.1111/os.14149. Epub 2024 Jun 30.
Periprosthetic femoral fractures (PPFFs) following total hip arthroplasty (THA) present a significant clinical challenge due to their increasing incidence with an aging population and evolving surgical practices. Historically, classifications were primarily based on anatomical fracture location, the stability of the implant, and bone quality surrounding the implant. We critically analyzed 25 classification systems, highlighting the emergence and adaptations of key systems such as the Vancouver classification system (VCS) and the Unified classification system (UCS), which are lauded for their simplicity and effectiveness yet require further refinement. VCS, developed in 1995, categorizes fractures based on the site, implant stability, and bone quality, and remains widely used due to its robust applicability across different clinical settings. Introduced in 2014, UCS expands the VCS to encompass all periprosthetic fractures with additional fracture types, aiming for a universal application. Despite their widespread adoption, these systems exhibit shortcomings, including the incomplete inclusion of all PPFF types and the imprecise assessment of implant stability and surrounding bone loss. These gaps can result in misclassification and suboptimal treatment outcomes. This paper suggests the necessity for ongoing improvements in classification systems to include emerging fracture types and refined diagnostic criteria, ensuring that they remain relevant to contemporary orthopedic practices and continue to facilitate the precise tailoring of treatment to patient-specific circumstances. This comprehensive historical review serves as a foundation for future innovations in classification systems, ultimately aiming to standardize PPFF treatment and improve patient prognosis.
全髋关节置换术（THA）后发生的假体周围股骨骨折（PPFFs），随着人口老龄化和外科手术方式的不断演变，其发病率日益增加，给临床带来了重大挑战。从历史上看，分类主要基于解剖学骨折部位、植入物的稳定性以及植入物周围的骨质。我们对25种分类系统进行了批判性分析，重点介绍了温哥华分类系统（VCS）和统一分类系统（UCS）等关键系统的出现及改进，这些系统因其简单性和有效性而受到赞誉，但仍需进一步完善。VCS于1995年开发，根据骨折部位、植入物稳定性和骨质对骨折进行分类，因其在不同临床环境中的强大适用性而仍被广泛使用。UCS于2014年推出将VCS扩展到涵盖所有假体周围骨折及更多骨折类型，旨在实现通用应用。尽管这些系统被广泛采用，但它们仍存在缺点，包括未完全涵盖所有PPFF类型，以及对植入物稳定性和周围骨质流失的评估不准确。这些差距可能导致分类错误和治疗效果欠佳。本文提出，分类系统有必要持续改进，以纳入新出现的骨折类型和完善诊断标准，确保它们与当代骨科实践相关，并继续便于根据患者具体情况精确制定治疗方案。这一全面的历史回顾为分类系统的未来创新奠定了基础，最终目标是规范PPFF治疗并改善患者预后。
