手术治疗髋关节假体周围骨折的治疗策略和临床疗效:来自一个高流量中心的分析。

IF 1.3 4区 医学 Q3 ORTHOPEDICS HIP International Pub Date : 2024-09-01 Epub Date: 2024-06-11 DOI:10.1177/11207000241256873
Fabio Mancino, Ben Wall, Thomas A Bucher, Gareth H Prosser, Piers J Yates, Christopher W Jones
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引用次数: 0

摘要

背景:全髋关节置换术(THA)后髋关节假体周围骨折(PPF)越来越普遍。其处理主要取决于骨折类型和植入物的稳定性。本研究旨在提供一个高产量中心手术治疗 PPF 的结果,以帮助指导未来的决策:这是一项回顾性研究,收集了 2008 年 1 月至 2021 年 1 月期间的前瞻性数据。研究收集了患者的人口统计学特征、植入物的具体细节和固定策略。收集的并发症包括感染、再次手术、再次骨折、再次修补。评估了 3 个月和 1 年的短期死亡率。P 值 结果:共发现 282 例经手术治疗的 PPF。52% 的病例以温哥华 B2 型为主。单纯翻修和翻修加额外固定是最常见的治疗方法,共 168 例(60%)。20%的病例出现了需要再次手术的并发症,其中以感染最为常见(8.5%)。3个月和1年的死亡率分别为7.8%和15.7%,其中B2型的死亡率明显较低。采用骨水泥柄治疗的B2型骨折的1年死亡率明显低于远端翻修:结论:PPF的并发症发生率较高。结论:PPF的并发症发生率较高,对于B2/B3型骨折,单纯翻修和翻修加额外固定仍是首选方法,但骨水泥翻修可获得相似的结果,且短期死亡率较低。考虑到高风险的老年和体弱患者,需要一个多学科团队来改善治疗效果并降低死亡率。
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Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre.

Background: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making.

Methods: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant.

Results: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions.

Conclusions: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
期刊最新文献
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