Hampshire Hospital NHS Foundation Trust, Hampshire, UK.
East and North Hertfordshire NHS Trust, Stevenage, UK.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3335-3345. doi: 10.1007/s00402-022-04603-1. Epub 2022 Sep 11.
The treatment of periprosthetic femur fractures around a total knee replacement remains a technical challenge for the orthopedic surgeon. Management options include non-operative treatment, plate fixation, intramedullary nailing and distal femur replacement (DFR), with few studies comparing fixation with DFR. This is an up-to-date meta-analysis in the literature to directly compare clinical outcomes between fixation and distal femoral replacement in the treatment of supracondylar periprosthetic femur fractures.
A stratified literature search of the Medline, EMBASE and Cochrane databases was performed. All studies in English language were searched from inception to July 2022. The search was performed with the following MeSH terms: Periprosthetic fracture AND ORIF OR Internal Fixation AND Distal Femur Replacement. The search was conducted using a predesigned search strategy where all eligible literature was critically appraised for methodological quality using the Cochrane collaboration tool. We included Level I, II and III studies comparing fixation with DFR in the treatment of periprosthetic supracondylar femur fractures. Data from eligible studies were extracted by two authors (NP and AR) and a table created which included author, year, sample size, mean age, measured parameters, follow-up period, fracture classification, length of stay (days), mortality rate, revision rate and complication rate.
The extracted data were pooled for meta-analysis using RevMan® v5.3.5 software (Nordic Cochrane Centre, Copenhagen, Denmark) and forest plots constructed. A p value < 0.05 was considered statistically significant and confidence intervals (CI) set to 95%. A total of six studies were included in the meta-analysis (n = 406). 153 patients underwent distal femur replacement and 253 patients underwent fixation with a mean follow-up time of 71.4 months. The results of this analysis suggest no statistically significant difference in measured outcomes.
The results of this meta-analysis suggest no proven statistically significant difference between DFR and fixation in terms of length of hospital stay, mortality rate, revision rate and complication rate for the treatment of periprosthetic supracondylar femur fractures. Further prospective randomized research may help to define the specific indications for each treatment option which must include fracture configuration. Early functional outcome and cost-effectiveness have yet to be evaluated in the available literature.
全膝关节置换周围的股骨假体周围骨折的治疗仍然是骨科医生面临的技术挑战。治疗方法包括非手术治疗、钢板固定、髓内钉和股骨远端置换（DFR），很少有研究比较固定与 DFR。这是对文献中直接比较固定与股骨远端置换治疗股骨假体周围髁上骨折的临床结果的最新荟萃分析。
对 Medline、EMBASE 和 Cochrane 数据库进行分层文献检索。从建库到 2022 年 7 月，检索所有英文文献。使用以下 MeSH 术语进行搜索：假体周围骨折和 ORIF 或内固定和股骨远端置换。使用预先设计的搜索策略进行搜索，对所有符合条件的文献使用 Cochrane 协作工具进行批判性评估，以确定其方法学质量。我们纳入了比较固定与 DFR 治疗股骨假体周围髁上骨折的 I、II 和 III 级研究。两位作者（NP 和 AR）提取符合条件的研究的数据，并创建一个表格，其中包括作者、年份、样本量、平均年龄、测量参数、随访时间、骨折分类、住院时间（天）、死亡率、翻修率和并发症发生率。
使用 RevMan® v5.3.5 软件（Nordic Cochrane Centre，哥本哈根，丹麦）对提取的数据进行荟萃分析，并构建森林图。p 值<0.05 被认为具有统计学意义，置信区间（CI）设定为 95%。荟萃分析共纳入 6 项研究（n=406）。153 例患者行股骨远端置换术，253 例患者行固定术，平均随访时间为 71.4 个月。该分析结果表明，测量结果无统计学显著差异。
这项荟萃分析的结果表明，在股骨假体周围髁上骨折的治疗中，DFR 和固定在住院时间、死亡率、翻修率和并发症率方面没有统计学上的显著差异。进一步的前瞻性随机研究可能有助于确定每种治疗选择的具体适应证，这必须包括骨折形态。早期功能结果和成本效益尚未在现有文献中得到评估。
