Prins Jonne, Donders Johanna C E, Helfet David L, Wellman David S, Klinger Craig E, Redko Mariya, Kloen Peter
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Orthopaedic Trauma Service, Center for Hip Preservation, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, United States.
Injury. 2018 Dec;49(12):2295-2301. doi: 10.1016/j.injury.2018.10.019. Epub 2018 Oct 18.
Periprosthetic femoral nonunions (PPFN) have a reported incidence of 3-9%. Literature on PPFN management is scarce. The study aim was to review combined results of two academic teaching hospitals using comparable PPFN treatment strategies.
A retrospective review was conducted of all patients treated for a PPFN between February 2005 and December 2016. All patients treated with internal fixation for a PPFN with complete clinical and radiological follow-up until healing were included. Nineteen patients were identified (mean age 71.2 years, range 49-87). Treatment consisted of failed hardware removal, debridement, reduction, and rigid internal fixation with or without bone graft. For revision PPFN surgery, use of dual-plating and bone graft augmentation was common.
Eighteen of 19 patients (94.7%) progressed to osseous union. One patient was converted to a total femoral prosthesis. No patients were lost to follow-up. All were ambulatory at last follow-up and mean follow-up was 39.8 months. Fourteen patients (73.7%) united after our index nonunion surgery at mean 9.8 months. Five patients (26.3%) required revision surgery after our index nonunion treatment and in 4 of these cases union was achieved at mean 18.0 months.
Our results suggest debridement, revision of fixation and liberal use of bone grafting can lead to reliable healing in the majority of PPFNs. For those PPFNs that do not heal following initial treatment, good healing potential persists with an additional procedure.
Prognostic Level III.
据报道，人工关节周围股骨不愈合（PPFN）的发生率为3%-9%。关于PPFN治疗的文献较少。本研究的目的是回顾两家学术教学医院采用可比的PPFN治疗策略的综合结果。
对2005年2月至2016年12月期间所有接受PPFN治疗的患者进行回顾性研究。纳入所有接受内固定治疗PPFN且有完整临床和影像学随访直至愈合的患者。共确定19例患者（平均年龄71.2岁，范围49-87岁）。治疗包括取出失效内固定物、清创、复位以及使用或不使用植骨的坚强内固定。对于翻修PPFN手术，双钢板固定和植骨增加术较为常用。
19例患者中有18例（94.7%）实现骨愈合。1例患者改为全股骨假体置换。无患者失访。末次随访时所有患者均能行走，平均随访时间为39.8个月。14例患者（73.7%）在首次不愈合手术后平均9.8个月实现愈合。5例患者（26.3%）在首次不愈合治疗后需要翻修手术，其中4例在平均18.0个月时实现愈合。
我们的结果表明，清创、固定翻修和大量使用植骨可使大多数PPFN可靠愈合。对于初次治疗后未愈合的PPFN，再次手术仍有良好的愈合潜力。
预后III级。
