Castillón Pablo, Muñoz Vives Josep Maria, Aguado Héctor José, Capel Agundez Arantxa, Ortega-Briones Alina, Núñez Jorge Hassan
Department of Trauma and Orthopaedic Surgery, Hospital, Universitari Mútua Terrassa, Terrassa, Barcelona, Spain.
Universidad Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.
EFORT Open Rev. 2024 Jan 9;9(1):40-50. doi: 10.1530/EOR-23-0105.
A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs. The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures. This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously. Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone. Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone. Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed. If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.
股骨假体周围骨折（PIFF）被定义为在已有非假体植入物的情况下发生的股骨骨折。针对假体周围骨折已有分类系统、治疗指南和固定策略，但关于股骨假体周围骨折尚无标准治疗方案。西班牙假体周围骨折共识（即PISCO）研究人员的目的是就目前股骨假体周围骨折的管理实践达成共识，并提出评估这些骨折手术治疗和预防的四项主要原则。本共识性综述是根据德尔菲法进行的。22名骨科创伤外科专家达成了共识，最终声明获得一致通过。在股骨假体周围骨折的手术治疗中必须采用生物学固定原则，其中包括闭合或微创复位技术。骨固定必须保护整个骨骼。应避免两个植入物之间出现间隙。如果无法实现植入物重叠，那么必须使用跨越植入物的固定系统，尤其是在骨质疏松性骨中。在股骨假体周围骨折的手术治疗过程中应保留先前的植入物。仅移除那些会干扰当前固定目标的植入物。如果先前的植入物位于股骨颈区域，那么在治疗股骨假体周围骨折时必须维持对股骨颈的保护，即使颈部骨折已经愈合。
