Tandon Tarang, Tadros Baha John, Avasthi Adhish, Hill Richard, Rao Madhu
Department of Orthopaedics, St Richards Hospital, Western Sussex Hospitals NHS Trust, Chichester, PO19 6SE, UK.
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):160-164. doi: 10.1016/j.jcot.2019.05.015. Epub 2019 May 22.
Our study compares the outcome and cost of distal femoral arthroplasty to that of Fixation (Plating/Retrograde Nailing) in the management of distal femur peri-prosthetic fractures.
We reviewed our database for patients admitted with peri-prosthetic distal femoral fractures between 2005 and 2013 (n = 61). The patients were stratified into 2 groups based on management method. The Distal Femoral Arthroplasty group (Group A) had 21 patients and the Fixation group (Group B) had 40 patients. Outcome & cost were compared. Minimum follow-up was 3 years.
The mean length of stay in group A was 9 days whereas in group B was 32 days. All patients were fully weight bearing by day 3 in group A, compared to a mean of 11 weeks in group B. Mean OKS was 28 and KSS score was 70 in group A compared to 27 and 68 in group B. In group A, there were 2 deaths, 1 superficial infection, and 1 DVT. In group B, there were 6 deaths, 1 failure of fixation, 6 mal-unions, 1 non-union and 2 infections. Overall, the distal femoral arthroplasty procedure costs approximately £9600 and the fixation group costs were on average of £9800.
Distal femoral arthroplasty appears to provide good clinical results, with comparable overall costs to fixation.
我们的研究比较了在处理股骨远端假体周围骨折时，股骨远端关节成形术与内固定术（钢板固定/逆行髓内钉固定）的疗效和成本。
我们回顾了2005年至2013年期间因股骨远端假体周围骨折入院的患者数据库（n = 61）。根据治疗方法将患者分为两组。股骨远端关节成形术组（A组）有21例患者，内固定组（B组）有40例患者。比较了疗效和成本。最短随访时间为3年。
A组的平均住院时间为9天，而B组为32天。A组所有患者在第3天即可完全负重，而B组平均为11周。A组的平均牛津膝关节评分（OKS）为28分，膝关节协会评分（KSS）为70分，而B组分别为27分和68分。A组有2例死亡、1例浅表感染和1例深静脉血栓形成。B组有6例死亡、1例固定失败、6例畸形愈合、1例骨不连和2例感染。总体而言，股骨远端关节成形术的费用约为9600英镑，内固定组的平均费用为9800英镑。
股骨远端关节成形术似乎能提供良好的临床效果，总体成本与内固定术相当。
