髋关节置换术中股骨假体周围骨折危险因素的分析

Risk factors of intraoperative periprosthetic femoral fractures during total hip arthroplasty

目的分析髋关节置换术中股骨假体周围骨折的发生情况和危险因素。方法选择本组自2002年1月至2008年12月所有行初次和翻修髋关节置换术患者共3021髋(初次置换术2718髋,翻修术294髋),分析术中股骨假体周围骨折的发生情况,并用Logistic回归分析骨折发生的相关因素,包括性别、年龄、术前诊断、假体类型、固定方式。用2检验进行初次置换和翻修术中发生骨折的差异性检验。结果总的术中股骨假体周围骨折发生率为5.7%(173/3021),其中初次置换发生率为4.0%(110/2718),翻修术发生率为21.4%(63/294)。初次置换应用骨水泥股骨假体术中骨折发生率为1.9%(8/429),非骨水泥股骨假体术中骨折发生率为4.5%(102/2289),初次置换术中骨折82.7%(91/110)发生于干骺端;翻修术应用骨水泥股骨假体术中骨折发生率为18.8%(21/112),非骨水泥股骨假体术中骨折发生率为23.1%(42/182),翻修术术中骨折62%(39/63)发生于骨干部。Logistic回归分析显示:初次髋关节置换术中骨折的危险因素包括性别、术前诊断、固定方式、假体类型;翻修术性别、年龄、假体固定方式不是引起术中骨折的危险因素。应用2检验,翻修术中股骨假体骨折的风险与初次置换相比差异有统计学意义(P<0.000),OR值为6.5,95%CI(4.6,9.1)。结论初次髋关节置换术中股骨假体周围骨折的发生率为4.0%,主要发生于干骺端(83.6%),女性、髋关节发育不良、髋部骨折、高位脱位、非骨水泥固定是术中骨折的危险因素;髋关节翻修术中股骨假体周围骨折的发生率(21.4%),远高于初次髋关节置换术,主要发生于骨干部(61.9%),骨折的发生与否可能主要取决于翻修时的骨质情况,性别、年龄、假体固定方式并不是主要的影响因素。

Objective To study the incidence and risk factors of intraoperative periprosthetic femoral fractures during total hip arthroplasty.Methods A total of 3021 primary and revision total hip arthroplasties were performed between January 2001 and December 2008.The incidence and locations of intraoperative periprosthetic femoral fractures were evaluated.Risk factors for fracture were analyzed with logistic regression.2 test was used to determine the difference of intraoperative periprosthetic femoral fractures between primary and revision total hip arthroplasty.Results Total incidence of intraoperative periprosthetic femoral fractures was 5.7% （173/3 021）.The incidence of intraoperative femoral fracture was 4.0% （110/2 718） in primary total hip arthroplasty and was 21.4% （63/294） in revision total hip arthroplasty.The rate of intraoperative femoral fracture during primary total hip arthroplasty was 1.9% （8/429） when a cemented stem was used,while it was 4.5% （102/2 289） when a cementless stem was used.The prevalence of intraoperative fractures in association with cemented stems in the revision total hip arthroplasty was 18.8% （21/112）,while it was 23.1% （42/182） in association with cementless stems.Female,some diseases （developmental dysplasia of hip,fracture of hip joint,and high riding hip）,cementless stem were risk factors associated with intraoperative periprosthetic femoral fractures in primary total hip arthroplasty,according to logistic regression.Gender,age,and modes of stem fixation were not the correlation factors in revision total hip arthroplasty.As the results of 2 test,the incidence rates of intraoperative periprosthetic femoral fractures had significant difference （P0.000,OR=6.5） between primary and revision total hip arthroplasty.Conclusions The incidence of intraoperative femoral fracture was 4.0% in primary total hip arthroplasty and 21.4% in revision total hip arthroplasty.Female,some diseases （Developmental dysplasia of hip,Fracture of hip joint,and high riding hip）,cementless stem may be the risk factors associated with intraoperative periprosthetic femoral fractures in primary total hip arthroplasty.Revision total hip arthroplasty has 6.5 times higher risk of intraoperative periprosthetic femoral fractures than that of primary total hip arthroplasty.Gender,age,and modes of stem fixation may be not the correlation factors in revision total hip arthroplasty.