全膝关节置换术后假体周围股骨远端骨折的最佳手术治疗：基于贝叶斯的网络分析。
Optimal surgical treatment for periprosthetic distal femoral fractures after total knee arthroplasty: a Bayesian-based network analysis.
机构信息
Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
出版信息
J Orthop Surg Res. 2023 Feb 20;18(1):122. doi: 10.1186/s13018-023-03586-y.
BACKGROUND
The surgical methods for periprosthetic distal femoral fractures (PDFFs) after total knee arthroplasty included locking compression plate (LCP), retrograde intramedullary nailing (RIMN), and distal femoral replacement (DFR). However, the optimal treatment remains controversial. We performed a network meta-analysis (NMA) to provide the optimal surgical method for PDFFs.
MATERIALS AND METHODS
Electronic databases, including Embase, Web of Science, Cochrane Library, and PubMed, were searched for studies that compared LCP, RIMN, and DFR for PDFFs. The quality of the included studies was assessed according to the Newcastle-Ottawa scale. Pairwise meta-analysis was performed by Review Manager version 5.4. The NMA was conducted in Aggregate Data Drug Information System software version 1.16.5. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications and reoperations.
RESULTS
A total of 19 studies and 1198 patients were included, of whom 733 for LCP, 282 for RIMN, and 183 for DFR. Pairwise meta-analysis comparing LCP to RIMN and LCP to DFR showed no significant difference in complications and reoperations except that RIMN had a higher risk of malunion comparing to LCP (OR 3.05; 95% CI 1.46-6.34; P = 0.003). No statistically significant effects were found in the NMA of overall complications, infection, and reoperation. However, results of rank probabilities showed that DFR ranked best in overall complications and reoperation, RIMN ranked best in infection but worst in reoperation, and LCP ranked worst in infection and middle in reoperation.
DISCUSSION
We found similar complication rate and reoperation rate between LCP, RIMN, and DFR. The results of rank probabilities favored DFR, and further studies with high-level evidence are expected to verify the optimal surgical method for PDFFs.
LEVEL OF EVIDENCE
Level II; network meta-analysis.
背景
全膝关节置换术后股骨假体周围远端骨折（PDFF）的手术方法包括锁定加压钢板（LCP）、逆行髓内钉（RIMN）和股骨远端置换（DFR）。然而，最佳治疗方法仍存在争议。我们进行了一项网络荟萃分析（NMA），以提供 PDFF 的最佳手术方法。
材料和方法
电子数据库，包括 Embase、Web of Science、Cochrane Library 和 PubMed，用于搜索比较 LCP、RIMN 和 DFR 治疗 PDFF 的研究。根据 Newcastle-Ottawa 量表评估纳入研究的质量。使用 Review Manager 版本 5.4 进行成对荟萃分析。在 Aggregate Data Drug Information System 软件版本 1.16.5 中进行 NMA。我们计算了术后并发症和再次手术的优势比（OR）和 95%置信区间（CI）。
结果
共纳入 19 项研究和 1198 例患者，其中 733 例接受 LCP 治疗，282 例接受 RIMN 治疗，183 例接受 DFR 治疗。比较 LCP 与 RIMN 和 LCP 与 DFR 的成对荟萃分析显示，除 RIMN 与 LCP 相比，畸形愈合的风险更高（OR 3.05；95%CI 1.46-6.34；P=0.003）外，并发症和再次手术无显著差异。NMA 中未发现总体并发症、感染和再次手术的统计学显著影响。然而，等级概率的结果表明，DFR 在总体并发症和再次手术中排名最佳，RIMN 在感染中排名最佳但在再次手术中排名最差，LCP 在感染中排名最差但在再次手术中排名中等。
讨论
我们发现 LCP、RIMN 和 DFR 之间的并发症发生率和再次手术率相似。等级概率的结果有利于 DFR，预计需要进一步进行高级别证据的研究来验证 PDFF 的最佳手术方法。
证据水平
二级；网络荟萃分析。
Zotero 插件