Rao Brian M, Stokey Phillip, Tanios Mina, Liu Jiayong, Ebraheim Nabil A
The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA.
J Orthop. 2022 Jul 31;33:105-111. doi: 10.1016/j.jor.2022.07.013. eCollection 2022 Sep-Oct.
Interprosthetic femur fractures (IFFs) are rare, but the treatment is challenging. Currently, there are many treatment methods used in practice, but an updated systematic review of comparison of common different surgical outcomes has not been thoroughly inspected.
A systematic review of retrospective studies was conducted. The resource databases of PubMed, Cochrane, and Embase were searched using a combination of the keywords involving IFFs and surgical outcomes from inception through June 2021. Data collected included patient demographics, intraoperative data, and postoperative outcomes. Outcomes were measured based on healing time, revision rate, complication rate, and functional scores.
Forty studies were included for review with a total of 508 patients. Average reported age of patients was 78.7 years old and 403 (79.3%) were females. Overall union rate was 74.0% with 376 of 508 patients achieving fracture union after primary treatment of IFF. Only 271 patients had reported healing times of fractures with a mean of 5.15 months. The plate, prosthetic revision, nail/rod, and external fixator groups had mean healing times of 4.69, 8.73, 6.5, and 5.1 months, respectively. Revision rates were highest in the femur replacement treatment group with 9 (32.1%) patients needing at least one reoperation surgery for any reason. Overall, hardware failure and non-unions were the most reported complications in treatment of IFFs. Postoperative functional outcome scores were available for 242 patients. Harris Hip Scores for the plate, revision, replacement, nail/rod, and plate + revision groups were 76.84, 77.14, 69.9, 77, and 78.4, respectively.
Each treatment method should be carefully considered by the surgeon depending on the patient. Locking plate was the most common method for the treatment of the patients with IFFs. Half of them combined with cerclage wires/cables. Around two thirds' patients could achieve union with the fastest mean healing time around 4.69 months. Other less common methods included prosthetic revision, femur replacement, nail/rod, external fixator, etc. A small number of patients treated with Ilizarov external fixator, and it has proven to be a viable option with few complications and high union rates.
人工关节置换术后股骨骨折（IFFs）较为罕见，但治疗具有挑战性。目前，实践中有多种治疗方法，但尚未对常见不同手术结果比较进行全面的系统评价。
进行一项回顾性研究的系统评价。通过组合使用从数据库建立至2021年6月期间涉及IFFs和手术结果的关键词，检索PubMed、Cochrane和Embase资源数据库。收集的数据包括患者人口统计学信息、术中数据和术后结果。根据愈合时间、翻修率、并发症发生率和功能评分来衡量结果。
纳入40项研究进行综述，共508例患者。报告的患者平均年龄为78.7岁，403例（79.3%）为女性。总体愈合率为74.0%，508例患者中有376例在IFF初次治疗后实现骨折愈合。仅271例患者报告了骨折愈合时间，平均为5.15个月。钢板、假体翻修、髓内钉/棒和外固定架组的平均愈合时间分别为4.69、8.73、6.5和5.1个月。股骨置换治疗组的翻修率最高，有9例（32.1%）患者因任何原因需要至少进行一次再次手术。总体而言，内固定失败和骨不连是IFF治疗中报告最多的并发症。242例患者有术后功能结果评分。钢板、翻修、置换、髓内钉/棒和钢板+翻修组的Harris髋关节评分分别为76.84、77.14、69.9、77和78.4。
外科医生应根据患者情况仔细考虑每种治疗方法。锁定钢板是治疗IFF患者最常用的方法。其中一半联合使用环扎钢丝/缆绳。约三分之二的患者能够实现愈合，平均愈合时间最快约为4.69个月。其他不太常见的方法包括假体翻修、股骨置换、髓内钉/棒、外固定架等。少数患者采用Ilizarov外固定架治疗，事实证明这是一种可行的选择，并发症少且愈合率高。
