Notch现象对初次全膝关节置换术后股骨侧假体周围骨折的影响  

Effect of Notch on femoral periprosthetic fractures after primary total knee arthroplasty

作　　者：文鹏飞 王亚康 张斌飞[1] 郝林杰[1] 郭建斌 王军[1] 马涛[1] 秦四清 姚颖 张育民[1] Wen Pengfei;Wang Yakang;Zhang Binfei;Hao Linjie;Guo Jianbin;Wang Jun;Ma Tao;Qin Siqing;Yao Ying;Zhang Yumin(Department of Hip Joint Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Department of Blood Transfusion,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院髋关节病区,西安710054 [2]西安交通大学附属红会医院输血科,西安710054

出　　处：《中华骨科杂志》2022年第3期141-148,共8页Chinese Journal of Orthopaedics

基　　金：西安市卫生健康委员会青年培育项目(2020qn18)。

摘　　要：目的探讨Notch对初次全膝关节置换术(total knee arthroplasty,TKA)后股骨侧假体周围骨折(periprosthetic fracture,PPF)的影响。方法回顾性收集2013年1月至2020年12月在西安市红会医院收治股骨侧PPF 34例患者的病历资料,男4例,女30例;年龄(69.2±7.2)岁(范围55~84岁)。通过性别和年龄按1∶3匹配初次全膝关节置换术后未发生PPF的102例患者为对照组,男12例,女90例;年龄(69.2±7.2)岁(范围55~84岁)。主要观察指标为患者的一般资料、下肢力线、假体类型及Nocth情况,再以Nocth的深度和Tayside分级进行亚组分析,分析其对PPF的影响。结果PPF组和对照组患者的性别、年龄、体质指数(body mass index,BMI)、手术侧别等基线资料的差异均无统计学意义。两组患者下肢力线的差异无统计学意义(χ^(2)=1.019,P=0.601),假体类型的差异无统计学意义(χ^(2)=1.545,P=0.214),有无Notch比例的差异亦无统计学意义(χ^(2)=3.548,P=0.060)。PPF组Notch的长度为(4.5±2.7)mm,对照组为(4.9±2.8)mm,差异无统计学意义(t=0.732,P=0.465)。进一步以Notch深度为3 mm为界及Tayside分级进行亚组分析,两组患者Notch深度分组(χ^(2)=11.262,P=0.004)及分级(χ^(2)=14.601,P=0.003)的差异均有统计学意义;与无Notch的患者相比,当Notch深度>3 mm时PPF的风险更高,比值比(odds ratio,OR)为4.88(95%CI为1.76,13.51)。当Notch深度达到Tayside分级3级或4级时,PPF的发生率会更高;与无Notch的患者相比,Tayside分级达到3级时发生PPF的风险将增加6.99倍(95%CI为1.85,26.32)。女性患者中PPF组与对照组间有无Notch比例的差异有统计学意义(χ^(2)=3.956,P=0.047),存在Notch的女性患者发生PPF的风险更高,OR为2.33(95%CI为1.01,5.43)。行右侧TKA的患者中,PPF组与对照组间有无Notch比例的差异有统计学意义(χ^(2)=5.502,P=0.019),存在Notch的右侧手术患者PPF的风险更高,OR为3.58(95%CI为1.19,10.75)。结论Notch对初次全膝关节置换术后股骨侧PPF的发生Objective To investigate the effect of Notch on periprosthetic fracture(PPF)of the femoral prosthesis after primary total knee arthroplasty.Methods A total of 34 patients diagnosed with femoral PPF at Xi'an Honghui Hospital were retrospectively collected from January 2013 to December 2020.There were 4 males and 30 females with a mean age of 69.2±7.2 years(range,55-84 years).A total of 102 patients without PPF were matched by gender and age as the control group in a ratio of 1∶3.There were 12 males and 90 females with a mean age of 69.2±7.2 years(range,55-84 years).The main observation indexes included patients'general information and factors such as coronal alignment,prosthesis design and Notch conditions.Then,subgroup analysis was performed with the depth and Tayside classification of Notch to analyze their effects on PPF.Results The PPF and control groups were comparable in terms of baseline information such as gender,age,body mass index(BMI),and surgical side.There was no significant difference between the two groups in coronal alignment(χ^(2)=1.019,P=0.601)and prosthesis design(χ^(2)=1.545,P=0.214).There was no statistical difference in Notch between the PPF and control groups(χ^(2)=3.548,P=0.060).The mean length of Notch in the PPF group was 4.5±2.7 mm,compared with 4.9±2.8 mm in the control group,with no significant difference between the two groups(t=0.732,P=0.465).Further subgroup analysis using a Notch depth of 3 mm as a cut-off and Tayside classification revealed a statistical difference between the two groups(χ^(2)=11.262,P=0.004;χ^(2)=14.601,P=0.003).Compared with patients without Notch,the risk of PPF was higher when the depth of Notch exceeded 3 mm,with an odds ratio(OR)of 4.88(95%CI:1.76,13.51).The incidence of PPF was higher when Notch depth reached Tayside grade 3 or 4.Compared with patients without Notch,the risk of PPF would be 6.99-fold(95%CI:1.85,26.32)higher when Notch depth reached grade 3.In female patients,there was a significant difference in Notch status between the PPF and c

关 键 词：关节成形术 置换 膝 假体周围骨折 股骨 

分 类 号：R687.4[医药卫生—骨科学]