Rinehart Dustin, Youngman Tyler, Ahn Junho, Huo Michael
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX, 75390-8883, USA.
Arthroplasty. 2021 Jun 11;3(1):24. doi: 10.1186/s42836-021-00080-w.
This study reviewed the literature regarding the patient-reported treatment outcomes of using either open reduction and internal fixation (ORIF) with a plate and screw system or intramedullary nail (IMN) fixation for periprosthetic distal femur fractures around a total knee arthroplasty.
A total of 13 studies published in the last 20 years met the inclusion criteria. The studies included 347 patients who were allocated to ORIF (n = 249) and IMN (n = 98) groups according to the implants used. The primary outcome measures were the Knee Society Score or the Western Ontario and McMaster Universities osteoarthritis index. The secondary outcome measures included knee range of motion and the rates of complications, including non-union, malunion, infection, revision total knee arthroplasty, and reoperation. Statistical significance was set at P < 0.05.
The mean Knee Society Scores of ORIF and IMN groups were 83 and 84, respectively; the mean postoperative range of motion of the knee were 99° and 100°, respectively (P < 0.05); the non-union rates were 9.4 and 3.8%, respectively (P > 0.05); the malunion rates were 1.8 and 7.5%, respectively (P < 0.05); surgical site infection rates were 2 and 1.3%, respectively (P > 0.05); the reoperation rates were 9.6 and 5.1%, respectively (P > 0.05); and revision rates of total knee arthroplasty were 2 and 1%, respectively (P > 0.05).
Based on the patient-reported outcome assessments, both ORIF with a plate and screw system and IMN fixation are well-accepted techniques for periprosthetic distal femur fractures around a TKA, and they produce similar functional outcomes.
本研究回顾了有关使用钢板螺钉系统切开复位内固定（ORIF）或髓内钉（IMN）固定治疗全膝关节置换周围股骨假体周围远端骨折的患者报告治疗结果的文献。
过去20年发表的13项研究符合纳入标准。这些研究包括347例患者，根据所使用的植入物分为ORIF组（n = 249）和IMN组（n = 98）。主要结局指标为膝关节协会评分或西安大略和麦克马斯特大学骨关节炎指数。次要结局指标包括膝关节活动范围和并发症发生率，包括骨不连、畸形愈合、感染、全膝关节置换翻修和再次手术。统计学显著性设定为P < 0.05。
ORIF组和IMN组的平均膝关节协会评分分别为83分和84分；术后膝关节平均活动范围分别为99°和100°（P < 0.05）；骨不连发生率分别为9.4%和3.8%（P > 0.05）；畸形愈合发生率分别为1.8%和7.5%（P < 0.05）；手术部位感染率分别为2%和1.3%（P > 0.05）；再次手术率分别为9.6%和5.1%（P > 0.05）；全膝关节置换翻修率分别为2%和1%（P > 0.05）。
基于患者报告的结局评估，钢板螺钉系统ORIF和IMN固定都是治疗TKA周围股骨假体周围远端骨折的广泛接受的技术，并且它们产生相似的功能结局。
