Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
J Arthroplasty. 2013 Oct;28(9):1580-4. doi: 10.1016/j.arth.2013.02.030. Epub 2013 Mar 26.
Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.
目前，全膝关节置换术后（TKA）的假体周围骨折固定方法多种多样，包括切开复位内固定（ORIF）、钢板固定、逆行髓内钉固定，或使用标准翻修 TKA 组件或股骨远端假体（DFA）进行翻修。本研究旨在比较初次 DFA 与因初次钢板固定失败而需要进一步行 DFA 翻修的患者。在 13 例（9.2%）初次 ORIF 失败的患者中，失败原因包括骨不连（53.8%）、感染（30.8%）、松动（7.7%）和再骨折（7.7%）。与初次 DFA 相比，ORIF 翻修至 DFA 的手术次数明显更多。行初次 DFA 重建的患者出现的并发症包括伸肌机制破坏（8.3%）、感染（5.6%）和脱位（2.8%）。初次 ORIF 重建有利于保留骨量，但对于骨质疏松患者或骨不连风险较高的患者，可能更倾向于行初次 DFA。
