Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; and.
J Orthop Trauma. 2023 Oct 1;37(10):480-484. doi: 10.1097/BOT.0000000000002624.
Comparing outcomes of periprosthetic distal femur fractures treated with open reduction and internal fixation (ORIF) versus distal femoral replacement (DFR).
Three major academic hospitals within one metropolitan area.
Retrospective.
PATIENTS/PARTICIPANTS: Three hundred seventy patients >64 years old with periprosthetic distal femur fractures were identified and 115 were included (65 ORIF vs. 50 DFR).
ORIF with locked plating versus DFR.
One-year mortality, ambulatory status at 1 year, reoperations, and hospital readmissions.
No differences were observed between ORIF and DFR cohorts regarding demographics or medical history, including Charleston Comorbidity Index. DFR was associated with longer hospital stay (6.09 days ORIF vs. 9.08 days DFR, P < 0.001) and more frequent blood transfusion (12.3% ORIF vs. 44.0% DFR, P < 0.001). Logistic regression analysis using propensity score matching (PSM) demonstrated no statistically significant difference in reoperation, hospital readmission, ambulatory status at 1 year, or 1-year mortality between the 2 cohorts. Finally, applying Bayesian model averaging using PSM to identify risk factors for 1-year mortality demonstrated that increasing age, length of index hospital stay, and 90-day hospital readmission were significantly associated with 1-year mortality, regardless of type of surgical treatment.
Rehospitalization, reoperation, ambulatory status, and 1-year mortality are no different between ORIF and DFR in the treatment of geriatric periprosthetic distal femur fractures when PSM is applied to mitigate selection bias. Further study is warranted to elucidate functional outcomes, long-term sequelae, and costs of care related to these treatment options to better guide treatment planning.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较切开复位内固定（ORIF）与股骨远端置换（DFR）治疗人工关节周围股骨远端骨折的疗效。
一个大都市区的 3 家主要学术医院。
回顾性研究。
患者/参与者：确定了 370 名年龄大于 64 岁的人工关节周围股骨远端骨折患者，其中 115 名患者符合纳入标准（65 例 ORIF 与 50 例 DFR）。
ORIF 采用锁定钢板与 DFR。
1 年死亡率、1 年时的活动状态、再手术和医院再入院。
ORIF 组和 DFR 组在人口统计学或病史方面（包括 Charlson 合并症指数）无差异。DFR 与较长的住院时间（ORIF 为 6.09 天，DFR 为 9.08 天，P<0.001）和更频繁的输血（ORIF 为 12.3%，DFR 为 44.0%，P<0.001）相关。使用倾向评分匹配（PSM）的 logistic 回归分析显示，两组间再手术、医院再入院、1 年时的活动状态和 1 年死亡率无统计学差异。最后，应用 PSM 的贝叶斯模型平均法确定 1 年死亡率的危险因素，结果表明，年龄增加、指数住院时间延长和 90 天内医院再入院与 1 年死亡率显著相关，而与手术治疗类型无关。
当应用 PSM 减轻选择偏倚时，ORIF 和 DFR 治疗老年人工关节周围股骨远端骨折的再住院率、再手术率、活动状态和 1 年死亡率无差异。需要进一步研究以阐明与这些治疗选择相关的功能结局、长期后果和护理成本，以便更好地指导治疗计划。
治疗性 III 级。有关证据水平的完整描述，请参阅作者指南。
