Vemulapalli Krishna C, Davis Stephen L, Mathews Vasilios, Goytia Robin N, Stocks Gregory W, Dunn Warren R, Laughlin Mitzi S, Brinker Mark R
Orthopedics. 2020 Jul 1;43(4):209-214. doi: 10.3928/01477447-20200428-04. Epub 2020 May 7.
Multiple studies have reported nonunion rates of 3% to 17% following peri-prosthetic fractures. Determining management strategies based on the available literature is difficult because existing studies are small and involve heterogeneous treatments and multiple surgeons. The purpose of this study was to describe a consecutive series of patients who presented to the authors' clinic with a periprosthetic nonunion of the lower extremity and to report the methods used to achieve limb salvage and the associated complications. Patients were included if they were indicated for surgery for a nonunion of a periprosthetic fracture of the lower extremity that had previously undergone either closed or open intervention. A total of 26 patients were included in this study. Average follow-up was 58 months. Average age was 69 years, and 77% of the patients were female. Twenty-three patients had periprosthetic nonunions of the femur, with 6 being associated with total hip arthroplasty, 15 with total knee arthroplasty, and 2 with both a total hip arthroplasty and a total knee arthroplasty. Three patients had a periprosthetic nonunion of the tibia associated with a total knee arthroplasty. Limb salvage was successful in 25 of 26 cases. This was achieved by either healing of the nonunion using exuberant fixation with prosthesis revision when necessary (n=20) or resection of the nonunion with placement of a tumor prosthesis (n=5). Four of the 26 patients (15%) incurred at least 1 complication during treatment. Exuberant fixation of the nonunion (with prosthesis revision when necessary) or nonunion resection with placement of a tumor prosthesis was successful in 96% of cases. [Orthopedics. 2020;43(4):209-214.].
多项研究报告称，假体周围骨折后的骨不连发生率为3%至17%。基于现有文献确定治疗策略很困难，因为现有研究规模较小，涉及异质性治疗方法且有多位外科医生参与。本研究的目的是描述一系列连续的患者，这些患者因下肢假体周围骨不连前来作者所在诊所就诊，并报告实现保肢所采用的方法及相关并发症。如果患者因先前接受过闭合或开放干预的下肢假体周围骨折骨不连而被建议手术，则纳入研究。本研究共纳入26例患者。平均随访时间为58个月。平均年龄为69岁，77%的患者为女性。23例患者为股骨假体周围骨不连，其中6例与全髋关节置换术相关，15例与全膝关节置换术相关，2例与全髋关节置换术和全膝关节置换术均相关。3例患者为与全膝关节置换术相关的胫骨假体周围骨不连。26例患者中有25例保肢成功。这是通过在必要时采用积极固定并翻修假体使骨不连愈合（n = 20）或切除骨不连并植入肿瘤假体（n = 5）实现的。26例患者中有4例（15%）在治疗期间发生至少1种并发症。骨不连的积极固定（必要时翻修假体）或切除骨不连并植入肿瘤假体在96%的病例中取得成功。[《骨科》。2020；43(4)：209 - 214。]
