Park K-C, Lim S-J, Song Y S, Hwang K-T
Department of orthopaedic surgery, Hanyang university, Guri hospital, 249-1 Gyomoon-dong, 471-701 Guri city, Gyunggi-do, Korea.
Department of orthopaedic surgery, Samsung medical center, 50 Ilwon-dong, 135-710 Gangnam-gu, Seoul, Korea.
Orthop Traumatol Surg Res. 2017 Dec;103(8):1201-1204. doi: 10.1016/j.otsr.2017.08.008. Epub 2017 Sep 19.
The purpose of this study is to evaluate the outcomes and to analyze the risk factors for the occurrence of peri-implant fracture after treatment of osteoporotic distal femoral fractures using a locking plate.
Risk factors affecting peri-implant fracture exist after locking plate fixation in osteoporotic distal femur fracture.
Eighty-nine cases (88 patients) with osteoporotic distal femoral fractures were evaluated between January 2006 and January 2014. The cohort included 13 men and 76 women with a mean age of 70.4 (50-91). Mean duration of follow-up was 47.9 months (12 to 106). All patients with distal femoral fracture were treated with a locking compression plate. Bone mineralized densitometry measurement was obtained from all patients. Risk factors including sex, age, rheumatoid arthritis (RA), taking of bisphosphonate, primary or periprosthetic fracture after total knee arthroplasty (TKA), open or closed fracture, types of the most proximal screw (locking/cortical), and number of proximal screws were analyzed. Complication, union, time to union, and range of motion of knee were also evaluated.
All patients had osteoporosis with the mean BMD of -3.16 (-2.5∼-5.4). The mean range of motion of knee was 126 degrees (90-145). Eighty-four cases (94.4%) showed union, the mean time to union was 14 weeks (10-42). Peri-implant fractures occurred in four patients (4.5%) after bone union at mean 37.5 months (14-62) postoperatively. Eight patients had angular deformities of over 5 degrees. Nonunion was observed in 5 cases and superficial wound infection in 2 cases. There were eight patients with RA, two of whom had suffered a peri-implant fracture. In statistical analysis, rheumatoid arthritis or periprosthetic fracture in TKA patients was a risk factor for peri-implant fracture (P=0.039, 0.019, respectively), and other factors showed no statistical differences.
Treatment using a locking plate showed favorable outcomes in osteoporotic distal femoral fractures. However, peri-implant fracture could occur in patients with RA or periprosthetic fracture after TKA. Therefore, cautious consideration is required for management of osteoporotic distal femur fracture in patients with RA or periprosthetic fracture after TKA. Analysis of more cases will be needed in order to achieve conclusive results.
Therapeutic study, level IV (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
本研究的目的是评估使用锁定钢板治疗骨质疏松性股骨远端骨折后的疗效，并分析发生植入物周围骨折的危险因素。
在骨质疏松性股骨远端骨折采用锁定钢板固定后，存在影响植入物周围骨折的危险因素。
对2006年1月至2014年1月期间的89例（88例患者）骨质疏松性股骨远端骨折患者进行评估。该队列包括13名男性和76名女性，平均年龄70.4岁（50 - 91岁）。平均随访时间为47.9个月（12至106个月）。所有股骨远端骨折患者均采用锁定加压钢板治疗。对所有患者进行骨矿密度测量。分析性别、年龄、类风湿关节炎（RA）、服用双膦酸盐、全膝关节置换术（TKA）后原发性或假体周围骨折、开放性或闭合性骨折、最近端螺钉类型（锁定/皮质）以及近端螺钉数量等危险因素。还评估了并发症、骨愈合情况、愈合时间以及膝关节活动范围。
所有患者均患有骨质疏松症，平均骨密度为 -3.16（-2.5至 -5.4）。膝关节平均活动范围为126度（90 - 145度）。84例（94.4%）显示骨折愈合，平均愈合时间为14周（10 - 42周）。4例患者（4.5%）在术后平均37.5个月（14 - 62个月）骨折愈合后发生植入物周围骨折。8例患者存在超过5度的角畸形。观察到5例骨不连和2例浅表伤口感染。有8例RA患者，其中2例发生了植入物周围骨折。在统计学分析中，RA或TKA患者的假体周围骨折是植入物周围骨折的危险因素（分别为P = 0.039，0.019），其他因素无统计学差异。
使用锁定钢板治疗骨质疏松性股骨远端骨折显示出良好的疗效。然而，RA患者或TKA后假体周围骨折的患者可能发生植入物周围骨折。因此，对于RA患者或TKA后假体周围骨折的骨质疏松性股骨远端骨折患者的治疗需要谨慎考虑。为了得出确凿的结果，需要分析更多病例。
治疗性研究，IV级（回顾性研究）。有关证据水平的完整描述，请参阅作者指南。
