Dehghan Niloofar, McKee Michael D, Nauth Aaron, Ristevski Bill, Schemitsch Emil H
*Department of Surgery, Division of Orthopaedics, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and †Department of Surgery, Division of Orthopaedics, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.
J Orthop Trauma. 2014 Dec;28(12):721-7. doi: 10.1097/BOT.0000000000000126.
Vancouver type B1 periprosthetic femur fractures occur around a stable implant and are typically treated with open reduction and internal fixation (ORIF). Different fixation techniques are described in the literature, and there is a lack of consensus regarding the best operative fixation strategy. The purpose of this investigation was to systematically review and compare the most commonly used fixation strategies for these fractures.
A database search was performed using PubMed, MEDLINE, and Cochrane databases to identify studies published in English language from 1985 to 2013.
Articles with a minimum of 5 patients with type B1 periprosthetic femur fractures and containing outcome data regarding nonunion, malunion, infection, and reoperation rate were included.
Studies were analyzed and categorized into 4 groups: group 1: ORIF with cortical strut allografts alone, group 2: ORIF with cable plate/compression plates alone, group 3: ORIF with cable plate/compression plates and cortical strut allograft, group 4: ORIF with locking plates alone. Individual patient outcomes were extracted for each study and pooled for each of the 4 groups. Data analysis was performed comparing rates of nonunion, malunion, hardware failure, infection, and reoperation.
Data were analyzed using Review Manager and SAS 9.3.
In total, 333 patients identified with an overall rate of 5% nonunion, 6% malunion, 5% infection, 4% hardware failure, 9% reoperation, and 15% total complications. When comparing outcomes for different modes of fixation, compared with cable plate/compression plate systems, locking plates had a significantly higher rate of nonunion (3% vs. 9% P = 0.02) and a trend toward a higher rate of hardware failure (2% vs. 7%, P = 0.07). There are limitations to this study, and further investigation with high-quality randomized controlled trials is needed to effectively compare treatment strategies.
温哥华B1型人工关节周围股骨骨折发生于稳定的植入物周围，通常采用切开复位内固定术（ORIF）治疗。文献中描述了不同的固定技术，对于最佳手术固定策略缺乏共识。本研究的目的是系统回顾和比较这些骨折最常用的固定策略。
使用PubMed、MEDLINE和Cochrane数据库进行数据库检索，以识别1985年至2013年发表的英文研究。
纳入至少有5例B1型人工关节周围股骨骨折患者且包含骨不连、畸形愈合、感染和再手术率等结局数据的文章。
研究被分析并分为4组：第1组：单纯使用皮质支撑异体骨的切开复位内固定术；第2组：单纯使用缆索钢板/加压钢板的切开复位内固定术；第3组：使用缆索钢板/加压钢板和皮质支撑异体骨的切开复位内固定术；第4组：单纯使用锁定钢板的切开复位内固定术。提取每项研究中个体患者的结局，并汇总到4组中的每组。进行数据分析以比较骨不连、畸形愈合、内固定失败、感染和再手术的发生率。
使用Review Manager和SAS 9.3进行数据分析。
总共识别出333例患者，总体骨不连发生率为5%，畸形愈合发生率为6%，感染发生率为5%，内固定失败发生率为4%，再手术发生率为9%，总并发症发生率为15%。比较不同固定方式的结局时，与缆索钢板/加压钢板系统相比，锁定钢板的骨不连发生率显著更高（3%对9%，P = 0.02），且内固定失败发生率有升高趋势（2%对7%，P = 0.07）。本研究存在局限性，需要进行高质量随机对照试验的进一步研究以有效比较治疗策略。
