Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2587-2594. doi: 10.1007/s00068-024-02567-y. Epub 2024 Jul 9.
With the rise in elderly populations, the incidence of femoral trochanteric fractures has also increased. Although intramedullary nail therapy is commonly used, the incidence of peri-implant fractures (PIFs) as a complication and its associated factors are not fully understood. The purpose of this study was to determine the incidence of PIFs and treatment strategies and outcomes.
A retrospective study across 11 hospitals from 2016 to 2020 examined 1855 patients with femoral trochanter fracture. After excluding 69 patients treated without intramedullary nailing, 1786 patients were analyzed. Parameters studied included age, sex, body mass index, medical history, and treatment methods. PIFs were categorized using the Chan classification. Treatment outcomes and patient mobility were assessed using the Parker Mobility Score, and postoperative complications and one-year survival data were compiled.
The incidence of PIFs was 8 in 1786 cases. Chan classification showed 1 case of N1A, 6 of N2A, and 1 of N2B. Only the type N1 case was a transverse fracture, whereas all cases of type N2 were oblique fractures. Among these cases, five patients had fractures extending to the upper part of the femoral condyle. The patient with N1A and one bedridden patient with N2A fracture underwent conservative treatment, one patient with N2A in which the fracture did not extend to the condyle was treated with nail replacement, and 5 patients (N2A: 4, N2B: 1) with fractures extending to the condyle were treated with additional plate fixation. All patients had survived at one year after treatment for PIF, and no reoperations were required.
The incidence of PIF was very low (0.45%). Of the 6 PIF cases, excluding the bedridden patients, the treatment of choice for PIF was an additional plate if the fracture line extended to the femoral condyle; otherwise, the nail was replaced. All patients achieved bony fusion.
Therapeutic Level IV.
随着老年人口的增加，股骨转子间骨折的发病率也有所增加。虽然髓内钉治疗较为常用，但作为并发症的假体周围骨折（PIF）及其相关因素尚不完全清楚。本研究旨在确定 PIF 的发生率以及治疗策略和结果。
本研究回顾性分析了 2016 年至 2020 年 11 家医院的 1855 例股骨转子间骨折患者。排除未行髓内钉治疗的 69 例患者后，共对 1786 例患者进行了分析。研究的参数包括年龄、性别、体重指数、既往病史和治疗方法。采用 Chan 分类法对 PIF 进行分类。采用 Parker 移动评分评估治疗结果和患者活动能力，并对术后并发症和一年生存率数据进行了汇总。
在 1786 例患者中，8 例发生 PIF。Chan 分类显示 N1A 型 1 例，N2A 型 6 例，N2B 型 1 例。仅 N1 型为横形骨折，而所有 N2 型均为斜形骨折。其中 5 例骨折延伸至股骨髁上部。N1A 型患者和 1 例 N2A 型卧床患者行保守治疗，1 例骨折未延伸至髁部的 N2A 型患者行髓内钉更换治疗，5 例（N2A 型 4 例，N2B 型 1 例）骨折延伸至髁部的患者行附加钢板固定治疗。所有 PIF 患者经治疗后均存活 1 年，无需再次手术。
PIF 的发生率非常低（0.45%）。在 6 例 PIF 患者中，排除卧床患者后，如果骨折线延伸至股骨髁，PIF 的治疗选择是附加钢板固定；否则更换髓内钉。所有患者均实现了骨融合。
治疗性 IV 级。
