Pohl Nicholas B, Saxena Arjun, Stambough Jeffrey B, Martin John Ryan, Mears Simon C, Lichstein Paul M
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Arthroplast Today. 2024 Aug 13;29:101428. doi: 10.1016/j.artd.2024.101428. eCollection 2024 Oct.
Periprosthetic femur fractures (PPFFs) following total hip arthroplasty (THA) have increased in the past decade as the demand for primary surgery continues to grow. Although there is now more evidence to describe the treatment of Vancouver B fractures, there is still limited knowledge regarding factors that cause surgeons to perform either an open reduction and internal fixation (ORIF) or revision THA (rTHA). The purpose of this study was to determine what type of surgeons treat Vancouver B PPFFs at 11 major academic institutions and if there are trends in treatment decision-making regarding the use of ORIF or rTHA based on surgical training or patient factors.
This multicenter retrospective study evaluated patients surgically treated for Vancouver B PPFF after THA between 2014 and 2019. Patients from 11 academic centers located in the United States were included in this study. Surgical outcomes and patient demographics were evaluated based on surgeon training, surgical treatment type, and institution.
Presence of Vancouver B2 (odds ratio [OR]: 0.02, < .001) or B3 (OR: 0.04, < .001) fractures were independent risk factors for treatment with rTHA. Treatment by a trauma (OR: 12.49, < .001) or other-specified surgeon (OR: 13.63, < .001) were independent risk factors for ORIF repair of Vancouver B fractures. There were no differences in outcomes based on surgeon subspecialty training.
This study showed the trends in surgeons who surgically manage Vancouver B fractures at 11 major academic institutions and highlighted that regardless of surgical training or surgical treatment type, postoperative outcomes following management of PPFF were similar.
在过去十年中，随着初次全髋关节置换术（THA）需求的持续增长，THA术后股骨假体周围骨折（PPFF）的发生率有所上升。尽管目前有更多证据描述温哥华B型骨折的治疗方法，但对于导致外科医生选择切开复位内固定术（ORIF）或翻修THA（rTHA）的因素，了解仍然有限。本研究的目的是确定在11家主要学术机构中，哪种类型的外科医生治疗温哥华B型PPFF，以及基于手术培训或患者因素，在使用ORIF或rTHA的治疗决策上是否存在趋势。
这项多中心回顾性研究评估了2014年至2019年间接受THA后因温哥华B型PPFF接受手术治疗的患者。本研究纳入了来自美国11个学术中心的患者。根据外科医生培训、手术治疗类型和机构对手术结果和患者人口统计学进行评估。
存在温哥华B2型（优势比[OR]：0.02，<.001）或B3型（OR：0.04，<.001）骨折是rTHA治疗的独立危险因素。由创伤外科医生（OR：12.49，<.001）或其他特定外科医生（OR：13.63，<.001）进行治疗是温哥华B型骨折ORIF修复的独立危险因素。基于外科医生亚专业培训的结果没有差异。
本研究显示了11家主要学术机构中手术治疗温哥华B型骨折的外科医生的趋势，并强调无论手术培训或手术治疗类型如何，PPFF治疗后的术后结果相似。
