与骨水泥型半髋关节置换术相比，非骨水泥型半髋关节置换术后假体周围股骨骨折的相关风险增加：一项对24419例股骨颈骨折的全国性数据库研究。
Increased associated risk of postoperative periprosthetic femur fracture with cementless versus cemented hemiarthroplasty: a nationwide database study of 24,419 femoral neck fractures.
作者信息
Rodgers Frank, Working Zachary M, Friess Darin, Yoo Jung, Kagan Ryland
机构信息
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR.
出版信息
OTA Int. 2025 Sep 10;8(4):e025. doi: 10.1097/OI9.0000000000000425. eCollection 2025 Dec.
OBJECTIVE
We evaluated the associated risk of postoperative periprosthetic femur fracture after hemiarthroplasty for the treatment of femoral neck fracture based on stem fixation, cementless compared with cemented.
DESIGN
A retrospective review of patient data from the PearlDiver database from 2015 to 2020.
SETTING
This database is comprised of 140 million deidentified patients based on national all-claims data including Medicare, Medicaid, government and private insurance.
PATIENTS/PARTICIPANTS: We identified 24,468 patients with hemiarthroplasty for treatment of femoral neck fracture from 2015 to 2020. Demographic data included; age, sex, diagnosis of obesity, and Charlson Comorbidity Index.
INTERVENTION
We identified postoperative periprosthetic femur fracture as our primary outcome and stratified femoral fixation as cemented 12,777 (52.2%) or cementless 11,691 (47.8%).
MAIN OUTCOME MEASUREMENTS
Propensity matched analysis with odds ratios (OR) was performed to evaluate association between fixation and odds of postoperative periprosthetic femur fracture; multivariate analysis was used to adjust for demographic characteristics and comorbidities.
RESULTS
Cementless fixation was associated with increased odds of post-operative periprosthetic femur fracture (OR 3.32 [95% confidence interval (CI), 2.75-4.00]; < 0.001). Females with cementless fixation had higher odds for post-operative periprosthetic femur fracture (OR 3.70 [95% CI, 2.94-4.76]; < 0.001).
CONCLUSIONS
We noted increased associated risk of postoperative periprosthetic femur fracture with cementless femoral fixation for hemiarthroplasty to treat femoral neck fracture, particularly in females. The risk of postoperative periprosthetic femur fracture should be considered as surgeons choose femoral fixation for hemiarthroplasty in the treatment of femoral neck fracture.
LEVEL OF EVIDENCE
Therapeutic Level III.
目的
我们基于柄部固定方式（非骨水泥型与骨水泥型相比较）评估了半髋关节置换术治疗股骨颈骨折后假体周围股骨骨折的相关风险。
设计
对2015年至2020年PearlDiver数据库中的患者数据进行回顾性分析。
背景
该数据库基于包括医疗保险、医疗补助、政府和私人保险在内的全国所有理赔数据，涵盖1.4亿名身份信息不明的患者。
患者/参与者：我们确定了2015年至2020年期间接受半髋关节置换术治疗股骨颈骨折的24468名患者。人口统计学数据包括年龄、性别、肥胖诊断和查尔森合并症指数。
干预措施
我们将术后假体周围股骨骨折确定为主要结局，并将股骨固定方式分为骨水泥型12777例（52.2%）或非骨水泥型11691例（47.8%）。
主要结局测量指标
采用倾向匹配分析及比值比（OR）来评估固定方式与术后假体周围股骨骨折几率之间的关联；多变量分析用于调整人口统计学特征和合并症。
结果
非骨水泥型固定与术后假体周围股骨骨折几率增加相关（OR 3.32 [95%置信区间（CI），2.75 - 4.00]；P < 0.001）。接受非骨水泥型固定的女性术后假体周围股骨骨折几率更高（OR 3.70 [95% CI，2.94 - 4.76]；P < 0.001）。
结论
我们注意到，在半髋关节置换术治疗股骨颈骨折时，非骨水泥型股骨固定会增加术后假体周围股骨骨折的相关风险，尤其是在女性患者中。在外科医生选择股骨固定方式进行半髋关节置换术治疗股骨颈骨折时，应考虑术后假体周围股骨骨折的风险。
证据水平
治疗性III级。
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