Märdian S, Schaser K-D, Scheel F, Gruner J, Schwabe P
Charité - University Medicine Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany.
Acta Chir Orthop Traumatol Cech. 2015;82(2):113-8.
PURPOSE OF THE STUDY The present study aimed to analyse both, the functional outcome and quality of life after surgical treatment of periprosthetic fractures following TKA. MATERIAL AND METHODS A retrospective review of all periprosthetic fractures following knee arthroplasty which have been surgically treated at our institution between January 2005 and January 2012 was conducted. Beside epidemiologic data, type of surgery and postoperative complications were recorded. The functional outcome was assessed using range of motion, Knee Society Score and VAS to evaluate pain. Quality of life was evaluated using SF-36 and WOMAC. Furthermore patients mobility and comorbidities were analysed. RESULTS 25 (mean age 76 ± 8 years; m:w 5:20) patients were included. The overall complication rate was 24%. Mean KSS knee score was 73 ± 19 and a function score was 41 ± 36. Range of motion revealed 95° ± 24° (active) and 98° ± 16° (passive). The total SF-36 scored a mean of 41 ± 6 and 29 ± 19 in average considering the WOMAC index (pain: 19 ± 20; stiffness: 23 ± 27; daily: 47 ± 29). 20% were able to mobilise without help as opposed to 80% that were in need for assistance. Our analysis revealed no influence of the final outcome as a function of fracture type or type of treatment. Multiple regression analysis could not reveal significant influence of the comorbidities. CONCLUSION Periprosthetic fractures following knee arthroplasty are accompanied by a significant decrease of the knee function and quality of life as well as high complication rates. Since patient's quality of life apparently depends on the functional outcome, future efforts should aim to improve these parameters. Key words: periprosthetic fracture, total knee arthroplasty, quality of life, functional outcome, locking plate.
研究目的 本研究旨在分析全膝关节置换术（TKA）后假体周围骨折手术治疗后的功能结局和生活质量。
材料与方法 对2005年1月至2012年1月在我院接受手术治疗的所有膝关节置换术后假体周围骨折进行回顾性研究。除了流行病学数据外，还记录了手术类型和术后并发症。使用活动范围、膝关节协会评分和视觉模拟评分（VAS）评估疼痛来评估功能结局。使用SF-36和WOMAC评估生活质量。此外，还分析了患者的活动能力和合并症。
结果 纳入25例患者（平均年龄76±8岁；男∶女 = 5∶20）。总体并发症发生率为24%。膝关节协会（KSS）膝关节平均评分为73±19，功能评分为41±36。活动范围显示主动活动为95°±24°，被动活动为98°±16°。考虑WOMAC指数（疼痛：19±20；僵硬：23±27；日常活动：47±29），SF-36总分平均为41±6，平均为29±19。20%的患者能够在无帮助下活动，而80%的患者需要帮助。我们的分析显示，最终结局不受骨折类型或治疗方式的影响。多元回归分析未发现合并症的显著影响。
结论 膝关节置换术后假体周围骨折伴有膝关节功能和生活质量的显著下降以及高并发症发生率。由于患者的生活质量显然取决于功能结局，未来应致力于改善这些参数。
假体周围骨折；全膝关节置换术；生活质量；功能结局；锁定钢板
