Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, ON, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
J Orthop Trauma. 2021 Nov 1;35(11):573-583. doi: 10.1097/BOT.0000000000002080.
To synthesize all-cause reoperations and complications data as well as secondary clinical and functional outcomes, after the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or distal femoral replacement (DFR).
MEDLINE, Embase, and Web of Science were searched for English language articles from inception to March 16, 2020, in accordance to the PRISMA guidelines.
Studies reporting the management of vDFPFs in adults older than 65 years with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur type III, (3) Backstein et al type F2, and/or (4) Kim et al type II or III.
Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for nonrandomized studies (MINORS), a quality assessment tool for nonrandomized controlled studies in surgery.
Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9-88.3 years) and 209 knees in the DFR group (mean age range: 71.0-84.8 years). Because of the literature's heterogeneity, the data were qualitatively synthesized.
vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0%-45% vs. 0%-77%, respectively). Time to weight-bearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
综合所有原因的再次手术和并发症数据，以及对老年患者人群中股骨远端假体周围骨折（vDFPF）采用远端股骨锁定钢板（DFLP）或远端股骨置换（DFR）治疗后的次要临床和功能结果。
根据 PRISMA 指南，从 MEDLINE、Embase 和 Web of Science 中搜索了从成立到 2020 年 3 月 16 日的英文文献，以获取相关文章。
纳入了报道了 65 岁以上成人采用 DFLP 或 DFR 治疗 vDFPF 的研究。为了确保本综述仅关注股骨远端假体周围非常远端的骨折，仅纳入以下分类的骨折：（1）Lewis 和 Rorabeck 型 II 或 III 型，（2）Su 和 Associates' 分类法的远端股骨髁上骨折 III 型，（3）Backstein 等 F2 型，和/或（4）Kim 等 II 或 III 型。
三位审稿人独立从纳入的研究中提取数据。使用非随机研究的方法学指数（MINORS）评估研究的有效性，这是非随机对照手术研究的质量评估工具。
纳入 25 项研究，共 649 例 vDFPF。DFLP 组有 440 个膝关节（平均年龄范围：65.9-88.3 岁），DFR 组有 209 个膝关节（平均年龄范围：71.0-84.8 岁）。由于文献的异质性，数据进行了定性综合。
与 DFLP 相比，老年患者采用 DFR 治疗的 vDFPF 再次手术率较低（分别为 0%-45%和 0%-77%）。DFR 研究中患者负重的时间明显短于 DFLP 研究。功能结果和术后活动范围表明 DFLP 膝关节的表现优于 DFR 膝关节。未来的研究应包括前瞻性研究和成本效益评估，以更好地了解 DFR 在这些骨折中的应用。
治疗性 III 级。请参阅作者指南以获取完整的证据水平描述。
