目的:非典型股骨假体周围骨折(APFFs)之间的确切关系,典型的股骨假体周围骨折(PFF),和不典型股骨骨折(AFFs)仍不清楚。本研究旨在调查PFF中APFF的患病率,并确定其临床特征。管理,以及将APFF与典型PFF和AFF区分开来的预后,以进一步确定这三种骨折类型之间的关系。
方法:在这项回顾性研究中,我们回顾了2012年1月至2022年12月期间髋关节置换术后发生PFF的117例连续患者的临床资料,并根据修订后的ASBMRAFF诊断标准将其进一步分为APFF组和典型PFF组.此外,纳入同期患有股骨转子下骨折或股骨干骨折且符合AFF诊断标准的患者,并将其归入AFF组.人口统计信息,AFF的次要特征,合并症,用药史,管理,收集并比较典型PFF患者的并发症,APFF,和AFF。
结果:11个PFF被确定为APFF,PFF中APFF的患病率为9.4%。发现皮质厚度的普遍增加存在显着差异(p=0.019),前驱症状(p<0.001),两组的双侧骨折发生率(p=0.010),这些次要特征在APFF组和AFF组中的发生率高于典型PFF组。值得注意的是,APFFs的骨折愈合时间明显长于典型PFFs和AFFs(分别为p<0.001和p=0.004)。此外,APFF组和AFF组的类风湿性关节炎患者比例较高(分别为p=0.004和p=0.027),双膦酸盐(BP)用量(分别为p=0.026和p<0.001),与典型的PFF组相比,BP使用时间更长(分别为p=0.003和p=0.007)。此外,两组之间的管理(p<0.001)和并发症发生率(p=0.020)存在显着差异,且APFF组和AFF组的并发症产生率高于典范PFF组。
结论:APFF不仅符合AFF的强制性和主要诊断标准,而且具有许多临床特征,管理和预后将它们与典型的PFF区分开来,但类似于AFF;因此,AFF的诊断标准可能会被修订,以纳入APFF作为该疾病的独特亚型.
OBJECTIVE: The exact relationship among atypical periprosthetic femoral fractures (APFFs), typical periprosthetic femoral fractures (PFFs), and atypical femur fractures (AFFs) remains unclear. This study aimed to investigate the prevalence of APFFs among PFFs and to identify the clinical characteristics, management, and prognosis that distinguish APFFs from typical PFFs and AFFs to further determine the relationship among these three fracture types.
METHODS: In this retrospective study, we reviewed the clinical data of 117 consecutive patients who had PFFs after hip arthroplasty between January 2012 and December 2022 and further classified them into an APFF group and a typical PFF group according to the revised ASBMR diagnostic criteria for AFF. Moreover, patients who had subtrochanteric or femoral shaft fractures in the same period and met the diagnostic criteria for AFF were recruited and classified into the AFF group. Demographic information, minor features of AFF, comorbidities, history of medication usage, management, and complications were collected and compared among patients with typical PFFs, APFFs, and AFFs.
RESULTS: Eleven PFFs were identified as APFFs, and the prevalence of APFFs among PFFs was 9.4%. Significant differences were found in generalized increase in cortical thickness (p = 0.019), prodromal symptoms (p < 0.001), and the incidence of bilateral fractures (p = 0.010) among the groups, where the incidences of these minor features in the APFF group and the AFF group were higher than those in the typical PFF group. Of note, the duration of fracture healing of APFFs was significantly longer than that of typical PFFs and AFFs (p < 0.001 and p = 0.004, respectively). In addition, the APFF group and the AFF group had higher proportions of patients with rheumatoid arthritis (p = 0.004 and p = 0.027, respectively), bisphosphonate (BP) usage (p = 0.026 and p < 0.001, respectively), and longer duration of BP usage (p = 0.003 and p = 0.007, respectively) than the typical PFF group. Furthermore, significant differences were found in management (p < 0.001) and complication rate (p = 0.020) among the groups, and the rate of complications in the APFF group and the AFF group was higher than that in the typical PFF group.
CONCLUSIONS: APFFs not only fulfilled the mandatory and major diagnostic criteria for AFF but also had many clinical characteristics, management and prognosis distinguishing them from typical PFFs but resembling AFFs; hence, the diagnostic criteria for AFF might be revised to incorporate APFF as a distinct subtype of the condition.