Atrey A, Hussain N, Gosling O, Giannoudis P, Shepherd A, Young S, Waite J
St Michael's Hospital, Toronto, Canada.
Michigan University, USA.
J Orthop. 2017 Jan 10;14(1):216-222. doi: 10.1016/j.jor.2016.12.006. eCollection 2017 Mar.
Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy.
In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ.
There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48.
In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.
尽管使用股骨远端骨折的内置假体仍然是一种有效的治疗选择，但广泛应用仍处于起步阶段。
在这个回顾性病例系列中，我们回顾了接受内置假体置换（EPR）治疗的股骨远端骨折病例。我们评估的结果包括开始活动的时间、出院时间、发病率和死亡率，以及用于评估疼痛和功能的牛津膝关节评分以及早期生存率。队列中的11例中有6例原位存在全膝关节置换术（TKR）。
我们的队列中有11个膝关节，平均年龄为81.5岁（范围52 - 102岁）。随访的中位时间为3.5年（范围1.6至5.5年）。手术的中位时间为3天，出院时间为16天。牛津功能和疼痛评分为32/48。
对于合适的患者和骨折类型，无论是否与现有的TKR相关，内置假体膝关节置换术都是治疗股骨远端骨折的极佳选择。该植入物比传统的切开复位内固定更昂贵，但术后更早恢复完全活动可能节省住院/护理院停留时间，释放医院空间并减少并发症。
