Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK.
Eur J Trauma Emerg Surg. 2019 Oct;45(5):841-848. doi: 10.1007/s00068-019-01103-7. Epub 2019 Feb 28.
Distal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures.
This systematic review was conducted in accordance with the PRISMA reporting guidelines. We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded (until October 2018) for studies and case series. Furthermore, clinical trial registries were searched for ongoing studies. We included all studies or case series that described total knee arthroplasty for distal femoral fractures irrespective of language, publication status, sample size, or follow-up period due to limited studies available in the literature. Exclusion criteria included single patient case reports, isolated tibia fractures, and periprosthetic fractures. Two authors independently identified trials for inclusion and independently extracted the data. Outcome measures included mortality, peri-operative complications (excluding mortality), anaesthetic time, blood loss, time to mobilisation, length of hospital stay, functional scores, radiological loosening, and revision rate.
Fourteen papers were included for subsequent quantitative and qualitative synthesis incorporating a total of 181 patients. The highest level of evidence identified was a single cohort study (level III), the remaining 13 papers consisted of multi- or single-centre case series (level IV). The mean mortality rate was 3.34% (range 0-10) at 30 days and 18.4% (range 0-42) at 1 year. The mean revision rate was 3.43% (range 0-25) at 1 year. The mean time to mobilisation was 3.90 days (range 2.5-6) with a mean time to discharge from the acute ward being 16.6 days (range 8-33).
Although there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.
老年人的股骨远端骨折与高发病率和死亡率相关，并且随着人口老龄化，其发病率正在上升。近年来，这些骨折的治疗方法已有了很大的发展，目前已经认识到急性关节置换术在治疗这些骨折方面的重要作用。我们的目的是系统地回顾文献中关于关节置换术作为股骨远端骨折治疗选择的证据。
本系统评价按照 PRISMA 报告指南进行。我们在 CENTRAL、MEDLINE、EMBASE 和科学引文索引扩展版（截至 2018 年 10 月）中搜索了研究和病例系列。此外，还搜索了临床试验注册处以寻找正在进行的研究。我们纳入了所有描述全膝关节置换术治疗股骨远端骨折的研究或病例系列，无论语言、出版状态、样本量或随访时间如何，因为文献中可用的研究有限。排除标准包括单例患者病例报告、孤立的胫骨骨折和假体周围骨折。两名作者独立确定纳入试验，并独立提取数据。结局指标包括死亡率、围手术期并发症（不包括死亡率）、麻醉时间、失血量、开始活动的时间、住院时间、功能评分、放射学松动和翻修率。
纳入了 14 篇后续进行定量和定性综合分析的论文，共纳入 181 例患者。确定的最高证据水平为一项单队列研究（III 级），其余 13 篇论文为多中心或单中心病例系列（IV 级）。30 天的死亡率平均为 3.34%（范围 0-10），1 年时的死亡率为 18.4%（范围 0-42）。1 年时的平均翻修率为 3.43%（范围 0-25）。开始活动的平均时间为 3.90 天（范围 2.5-6），从急症病房出院的平均时间为 16.6 天（范围 8-33）。
尽管文献中可用的证据有限，但我们的综述表明，急性膝关节置换术在股骨远端骨折中有一定的作用。这种治疗方式具有令人满意的死亡率和翻修率，可能导致更快的活动和出院时间。需要更高水平的证据来进一步阐明这个问题。
