初次髋关节置换术中股骨假体周围骨折的危险因素分析

The Analysis of Risk Factors for Intraoperative Femoral Periprosthetic Fracture During the Primary Hip Arthroplasty

目的探讨初次髋关节置换术中股骨假体周围骨折的危险因素、损伤机制、骨折分布特征。方法回顾性分析2015年1月至2020年12月行髋关节置换术的1633例(1633髋)髋关节临床资料,其中男688例,女945例;年龄26~96岁,平均(64.2±13.1)岁。根据患者髋关节置换术中是否发生股骨骨折,将全部患者分为骨折组与非骨折组,分析术中股骨骨折发生率、危险因素、损伤机制、骨折类型等。初次髋关节置换术中股骨骨折的危险因素先进行单因素分析,得出有显著差异性的因素,再进行二分类Logistic回归分析,排除混杂因素。结果初次髋关节置换术中股骨假体周围骨折发生率为3.9%(63/1633)。单因素分析显示骨折组与非骨折组在患者年龄构成(<60岁与≥60岁)、是否肥胖(身体质量指数≤28 kg/m 2与>28 kg/m 2)、股骨髓腔形态类型、手术入路、假体类型、手术医生手术量(<50髋/年与≥50髋/年)等差异有统计学意义(P<0.05)。多因素Logistic回归分析显示年龄、手术医生手术量、手术入路、股骨形态、假体类型是初次髋关节置换术中发生股骨假体周围骨折的危险因素。初次置换术中股骨发生Vancouver A型骨折41例(65.1%,41/63),术中骨折主要发生于扩髓和置入假体的过程中(92.1%,58/63)。结论初次髋关节置换术中股骨假体周围骨折发生率为3.9%,主要发生在转子部。股骨假体周围骨折与患者年龄、医生手术量、假体类型、手术入路、股骨形态密切相关。

Objective To explore the risk factors,the injury mechanism and distribution characteristics of intraoperative periprosthetic femoral fractures during hip arthroplasty.Methods A retrospective study was carried out on 1633 patients(1633 hips)hip arthroplasty between January 2015 and December 2020.There were 688 men and 945 women,and the age of patients ranged from 26 to 96 with an average age of(64.2±13.1)years.We divided all patients into fracture group and non-fracture group based on whether they had experienced femoral fractures during hip replacement surgery,analyzed the incidence,the risk factors,the injury mechanism and the type of intraoperative periprosthetic femoral fractures.Risk factors were studied according to univariate analysis,then got rid of the confound factors according to binary logistic regression analysis.Results The incidence of intraoperative periprosthetic femoral fractures was 3.9%(63/1633).Univariate analysis showed that there were statistically significant differences between the fracture group and the non-fracture group in patient age(<60 years,≥60 years),obesity(BMI≤28 kg/m 2,>28 kg/m 2),femoral medullary cavity morphology type,surgical approach,prosthesis type,and surgeon’s surgical volume(<50 hips/year,≥50 hips/year)(P<0.05).Multivariate logistic regression analysis showed that age,surgeon’s surgical volume,surgical approach,femoral morphology,and prosthesis type were risk factors for femoral periprosthetic fractures during initial hip replacement surgery.The femur fracture mainly occurred the Vancouver type A(65.1%,41/63)and intraoperative fractures mainly occured during the process of reaming and implant placement(92.1%,58/63).Conclusion The incidence of intraoperative periprosthetic femoral fractures was 3.9%,mainly occurring femoral trochanter.Periprosthetic fractures of the femur are closely related to age,surgeon’s surgical volume,the type of prosthesis,surgical approach and femoral morphology.