Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States.
Division of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, United States.
Injury. 2020 Apr;51(4):1062-1068. doi: 10.1016/j.injury.2020.02.043. Epub 2020 Feb 16.
The incidence of periprosthetic fracture following total knee arthroplasty continues to rise as the number of knee arthroplasty procedures increases. Management of periprosthetic fractures can be complex, with locked compression plating (LCP) and intramedullary nailing (IMN) being the most commonly used treatment options. We performed a systematic review to report and compare the clinical and radiographic outcomes of patients treated with intramedullary nail fixation versus plate fixation for periprosthetic fractures of the distal femur.
Several databases were screened. Studies evaluating intramedullary nail fixation or locked plate fixation for distal femur periprosthetic fractures were included. Primary and secondary variables as mentioned below, when included, were analyzed and compared.
One prospective comparative study, 9 retrospective comparative studies, and 28 retrospective case series with 1,188 patients were included in this review. No statistically significant differences were found between IMN and LCP when analyzing union rate or time to union. Plating demonstrated a statistically significant decrease in the overall complication rate and reoperation rate when compared with IMN (p<0.003). IMN demonstrated a slightly higher percentage of patients reaching full weight bearing status and a quicker time to full weight bearing (100% and 7.6 weeks) when compared to plating (94% and 15.8 weeks). A higher percentage of patients treated with IMN returned to preinjury activity when compared to those treated with plating (70.8% vs. 61.6%).
Both intramedullary nail and locked plate fixation offer unique benefits in terms of clinical and radiographic outcomes for treatment of periprosthetic distal femur fractures after total knee arthroplasty. While the standard of care remains controversial, an increase in the recent literature has allowed for better clarification of the significant clinicoradiologic advantages and disadvantages of both popular treatment options.
随着膝关节置换手术数量的增加，全膝关节置换术后假体周围骨折的发病率持续上升。假体周围骨折的治疗可能很复杂，锁定加压钢板（LCP）和髓内钉（IMN）是最常用的治疗选择。我们进行了系统评价，报告并比较了使用髓内钉固定与钢板固定治疗股骨远端假体周围骨折的患者的临床和影像学结果。
筛选了多个数据库。纳入评估股骨远端假体周围骨折髓内钉固定或锁定钢板固定的研究。分析和比较了以下主要和次要变量，如有包括。
本综述纳入了 1 项前瞻性对照研究、9 项回顾性对照研究和 28 项回顾性病例系列研究，共 1188 例患者。在分析愈合率或愈合时间时，IMN 和 LCP 之间没有发现统计学上的显著差异。与 IMN 相比，钢板固定在总体并发症发生率和再次手术率方面有统计学显著降低（p<0.003）。与钢板固定相比，IMN 有更高比例的患者达到完全负重状态和更快的完全负重时间（100%和 7.6 周）（94%和 15.8 周）。与钢板固定相比，更多接受 IMN 治疗的患者恢复到受伤前的活动水平（70.8%比 61.6%）。
髓内钉和锁定钢板固定在全膝关节置换术后股骨远端假体周围骨折的临床和影像学结果方面都有独特的优势。虽然治疗标准仍存在争议，但最近文献的增加使这两种流行的治疗选择的重要临床和影像学优缺点得到了更好的阐明。
