Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Knee. 2022 Aug;37:121-131. doi: 10.1016/j.knee.2022.06.008. Epub 2022 Jun 27.
The number of periprosthetic fractures above a total knee arthroplasty continues to increase. These fractures are associated with a high risk of morbidity and mortality. Techniques for addressing these fractures include open reduction internal fixation (ORIF) and revision arthroplasty, including distal femoral replacement (DFR). The primary aim of this review is to compare mortality and reoperation rates between ORIF and DFR when used to treat periprosthetic distal femur fractures.
A systematic review including MEDLINE, Embase and Cochrane Library databases was completed from inception to April 10, 2021. Studies including a comparator cohort were meta-analyzed.
Fourteen studies were identified for inclusion, of which, five had sufficient homogeneity for inclusion in a meta-analysis. 30-day and 2-year mortality was 4.1% and 14.6% in the DFR group. There was no statistically significant difference between ORIF and DFR (log Odds-Ratio (OR) = -0.14, 95 %CI: -0.77 to 0.50). The reoperation rate in the DFR group was 9.3% versus 14.8% for ORIF, with no difference between groups (log OR = 0.10, 95 %CI: -0.59 to 0.79). There was no difference in rates of deep infection (log OR = 0.22, 95 %CI: -0.83 to 1.28). Direct comparison of functional outcomes was not possible, though did not appear significant.
DFR in the setting of periprosthetic distal femur fractures is equivalent to ORIF with respect to mortality and reoperation rate and thus a safe and reliable treatment strategy. DFR may be more reliable in complex fracture patterns where the ability to obtain adequate fixation is difficult.
全膝关节置换术后假体周围骨折的数量持续增加。这些骨折与高发病率和死亡率相关。处理这些骨折的技术包括切开复位内固定（ORIF）和翻修关节置换术，包括股骨远端置换术（DFR）。本综述的主要目的是比较 ORIF 和 DFR 治疗假体周围股骨远端骨折的死亡率和再次手术率。
从创建到 2021 年 4 月 10 日，我们完成了一项包括 MEDLINE、Embase 和 Cochrane 图书馆数据库的系统评价。对纳入的比较队列研究进行了荟萃分析。
确定了 14 项研究纳入，其中 5 项具有足够的同质性，可纳入荟萃分析。DFR 组的 30 天和 2 年死亡率分别为 4.1%和 14.6%。ORIF 和 DFR 之间在统计学上无显著差异（对数优势比（OR）= -0.14，95%CI：-0.77 至 0.50）。DFR 组的再手术率为 9.3%，ORIF 组为 14.8%，两组之间无差异（对数 OR= 0.10，95%CI：-0.59 至 0.79）。深部感染率也无差异（对数 OR= 0.22，95%CI：-0.83 至 1.28）。虽然直接比较功能结局似乎没有意义，但无法进行比较。
在假体周围股骨远端骨折的情况下，DFR 在死亡率和再次手术率方面与 ORIF 相当，因此是一种安全可靠的治疗策略。DFR 可能在难以获得足够固定的复杂骨折模式中更可靠。
