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Abstract：
Periprosthetic femoral fractures (PPFFs) following total hip arthroplasty (THA) present a significant clinical challenge due to their increasing incidence with an aging population and evolving surgical practices. Historically, classifications were primarily based on anatomical fracture location, the stability of the implant, and bone quality surrounding the implant. We critically analyzed 25 classification systems, highlighting the emergence and adaptations of key systems such as the Vancouver classification system (VCS) and the Unified classification system (UCS), which are lauded for their simplicity and effectiveness yet require further refinement. VCS, developed in 1995, categorizes fractures based on the site, implant stability, and bone quality, and remains widely used due to its robust applicability across different clinical settings. Introduced in 2014, UCS expands the VCS to encompass all periprosthetic fractures with additional fracture types, aiming for a universal application. Despite their widespread adoption, these systems exhibit shortcomings, including the incomplete inclusion of all PPFF types and the imprecise assessment of implant stability and surrounding bone loss. These gaps can result in misclassification and suboptimal treatment outcomes. This paper suggests the necessity for ongoing improvements in classification systems to include emerging fracture types and refined diagnostic criteria, ensuring that they remain relevant to contemporary orthopedic practices and continue to facilitate the precise tailoring of treatment to patient-specific circumstances. This comprehensive historical review serves as a foundation for future innovations in classification systems, ultimately aiming to standardize PPFF treatment and improve patient prognosis.
摘要：
全髋关节置换术（THA）后的股骨假体周围骨折（PPFF）由于其发病率随着人口老龄化和外科手术实践的发展而增加，因此提出了重大的临床挑战。历史上,分类主要基于解剖骨折位置，植入物的稳定性，和植入物周围的骨骼质量。我们批判性地分析了25个分类系统，强调温哥华分类系统（VCS）和统一分类系统（UCS）等关键系统的出现和适应，因其简单性和有效性而受到称赞，但需要进一步完善。VCS,1995年开发，根据场地对骨折进行分类，植入物稳定性，和骨骼质量，并且由于其在不同临床环境中的强大适用性而仍然被广泛使用。UCS于2014年推出，将VCS扩展为涵盖所有具有其他骨折类型的假体周围骨折。旨在普遍应用。尽管它们被广泛采用，这些系统表现出缺点，包括所有PPFF类型的不完全包含，以及对植入物稳定性和周围骨丢失的不精确评估。这些差距可能导致错误分类和次优治疗结果。本文提出了持续改进分类系统的必要性，以包括新出现的骨折类型和完善的诊断标准，确保它们仍然与当代骨科实践相关，并继续促进根据患者具体情况进行精确的治疗。这一全面的历史回顾为分类系统的未来创新奠定了基础，最终旨在规范PPFF治疗并改善患者预后。
