Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA.
Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14620, USA.
Arch Orthop Trauma Surg. 2021 Jun;141(6):997-1006. doi: 10.1007/s00402-021-03866-4. Epub 2021 Mar 20.
Our purpose was to perform a systematic review and meta-analysis to evaluate complication and revision rates for periprosthetic distal femur fractures (PPDFF) treated with: (1) ORIF using periarticular locking plates (ORIF), (2) retrograde intramedullary nail (IMN), and (3) distal femoral replacement (DFR).
Systematic review of the literature was performed to identify eligible studies (N = 52). Identified treatment groups were: ORIF (N = 1205 cases), IMN (N = 272 cases), and DFR (N = 353 cases). Median follow-up was 30 months (range 6-96 months). Primary outcomes were: (1) major complication rates and (2) reoperation rates over the follow-up period. Secondary outcomes were incidence of deep infection, periprosthetic fracture, mortality over the follow-up period, 1-year mortality, non-union, malunion, delayed union, and hardware failure. Data for primary and secondary outcomes were pooled and unadjusted analysis was performed. Meta-analysis was performed on subset of individual studies comparing at least two of three treatment groups (N = 14 studies). Odds-ratios and their respective standard errors were determined for each treatment group combination. Maximum likelihood random effects meta-analysis was conducted for primary outcomes.
From the systematic review, major complication rates (p = 0.55) and reoperation rates (p = 0.20) were not significantly different between the three treatment groups. DFR group had a higher incidence of deep infection relative to IMN and ORIF groups (p = 0.03). Malunion rates were higher in IMN versus ORIF (p = 0.02). For the meta-analysis, odds of major complications were not significantly different between IMN versus DFR (OR 1.39 [0.23-8.52]), IMN versus ORIF (OR 0.86 [0.48-1.53]), or the ORIF versus DFR (OR 0.91 [0.52-1.59]). Additionally, odds of a reoperation were not significantly different between IMN versus DFR (OR 0.59 [0.08-4.11]), IMN versus ORIF (OR 1.26 [0.66-2.40]), or ORIF versus DFR (OR 0.91 [0.51-1.55]).
There was no difference in major complications or reoperations between the three treatment groups. Deep infection rates were higher in DFR relative to internal fixation, malunion rates were higher in IMN versus ORIF, and periprosthetic fracture rates were higher in DFR and IMN versus ORIF.
本研究旨在进行系统回顾和荟萃分析，以评估采用以下方法治疗的人工膝关节假体远端股骨骨折（PPDFF）的并发症和翻修率：（1）使用关节周围锁定钢板（ORIF）的切开复位内固定（ORIF），（2）逆行髓内钉（IMN），和（3）股骨远端置换（DFR）。
对文献进行系统回顾，以确定符合条件的研究（N=52）。确定的治疗组为：ORIF（N=1205 例），IMN（N=272 例）和 DFR（N=353 例）。中位随访时间为 30 个月（6-96 个月）。主要结局为：（1）主要并发症发生率和（2）随访期间的再次手术率。次要结局为深部感染、假体周围骨折、随访期间的死亡率、1 年死亡率、骨不连、畸形愈合、延迟愈合和内固定失败。对主要和次要结局的数据进行汇总，并进行未调整的分析。对至少比较三种治疗组中的两种的个别研究进行荟萃分析（N=14 项研究）。确定了每种治疗组组合的比值比及其相应的标准误差。对主要结局进行最大似然随机效应荟萃分析。
从系统回顾中，三组之间的主要并发症发生率（p=0.55）和再次手术率（p=0.20）没有显著差异。DFR 组与 IMN 和 ORIF 组相比，深部感染发生率更高（p=0.03）。IMN 组的畸形愈合发生率高于 ORIF 组（p=0.02）。对于荟萃分析，IMN 与 DFR 之间（OR 1.39 [0.23-8.52]）、IMN 与 ORIF 之间（OR 0.86 [0.48-1.53]），或 ORIF 与 DFR 之间（OR 0.91 [0.52-1.59]）发生主要并发症的几率没有显著差异。此外，IMN 与 DFR 之间（OR 0.59 [0.08-4.11]）、IMN 与 ORIF 之间（OR 1.26 [0.66-2.40]）或 ORIF 与 DFR 之间（OR 0.91 [0.51-1.55]）的再次手术几率没有显著差异。
三组之间的主要并发症或再次手术没有差异。DFR 组的深部感染发生率高于内固定组，IMN 组的畸形愈合发生率高于 ORIF 组，DFR 和 IMN 组的假体周围骨折发生率高于 ORIF 组。
