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首页> 外文期刊>Bulletin of the Hospital for Joint Diseases >Femoral Periprosthetic Fracture Nonunion Management and Outcomes with Nonunion Repair and Retention of Primary Components
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Femoral Periprosthetic Fracture Nonunion Management and Outcomes with Nonunion Repair and Retention of Primary Components

机译：股骨骨髓性骨折骨折管理和初级组分维修和保留的骨折管理和结果

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Introduction: Nonunion of a femoral periprosthetic fracture is a rare occurrence in orthopedic practice. Failure of a periprosthetic fracture to heal can lead to substantial disability and pain for patients as well as the potential need for component revision. Relatively little literature exists describing their management and outcome. Methods: Eleven patients with femoral periprosthetic fracture nonunion who presented for tertiary care were enrolled in a prospective data registry. Patients were considered to have developed nonunion following failure of progression in radiographic and clinical healing for a 6-month period. All patients were seen at standard postoperative intervals, and outcomes were recorded using the Short Musculoskeletal Function Assessment (SMFA), visual analog scale (VAS) for pain, physical examination, and radiographic examination. Preoperative radiographs were reviewed for classification. Results: Eleven patients had periprosthetic femoral fracture nonunion associated with prior hip (five patients) or knee (six patients) arthroplasty and were included in our study. Mean follow-up time was 30 months. Mean age at time of nonunion surgery was 64.5 years (range: 41.8 to 78.2 years). All patients underwent removal of previous fracture hardware at time of nonunion surgery. Ten (91%) of 11 received autogenous iliac crest bone grafting at time of nonunion surgery. Ten (91%) of the 11 patients went on to union without further intervention. Mean time to union was 7.9 months (SD: 8.0). The one patient that developed a persistent nonunion was complicated by infection requiring multiple irrigation and debridement procedures and total hip explant. The mean improvement in total SMFA score from baseline to final follow-up was 22.6 (p = 0.030). The greatest functional improvement was in the bothersome index at 28.0 (p = 0.028). The mean improvement in VAS pain score from baseline to final follow-up was 4.5 (p = 0.013). Discussion: Periprosthetic fracture nonunions can be successfully treated with operative intervention aimed at compression plating with bone graft and retention of primary components. In addition, successful periprosthetic nonunion repair improves function and pain in these patients.
机译：简介：股骨假体周围骨折不愈合在骨科实践中很少见。假体周围骨折无法愈合可能会导致患者严重残疾和疼痛，并可能需要对部件进行翻修。描述其管理和结果的文献相对较少。方法：11例股骨假体周围骨折不愈合的三级护理患者被纳入前瞻性数据登记。在6个月的时间里，患者被认为在影像学和临床治疗进展失败后出现骨不连。所有患者均在标准的术后时间间隔进行观察，并使用短期肌肉骨骼功能评估（SMFA）、疼痛视觉模拟量表（VAS）、体格检查和放射学检查记录结果。对术前X线片进行分类。结果：11例患者因髋关节（5例）或膝关节（6例）置换术后出现假体周围股骨骨折不愈合，纳入我们的研究。平均随访时间为30个月。骨不连手术时的平均年龄为64.5岁（范围：41.8至78.2岁）。所有患者均在骨不连手术时移除了先前的骨折硬件。11例中有10例（91%）在骨不连手术时接受了自体髂骨移植。11名患者中有10名（91%）在没有进一步干预的情况下继续愈合。平均愈合时间为7.9个月（标准差：8.0）。其中一名患者出现持续性骨不连，并发感染，需要多次冲洗、清创和全髋关节移植。从基线检查到最终随访，SMFA总分的平均改善率为22.6（p=0.030）。功能改善最大的是烦人指数为28.0（p=0.028）。从基线检查到最终随访，VAS疼痛评分的平均改善率为4.5（p=0.013）。讨论：假体周围骨折不愈合可以通过手术干预成功治疗，手术干预旨在加压钢板加植骨和保留主要部件。此外，成功的假体周围骨不连修复可改善这些患者的功能和疼痛。

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