Al-Jabri Talal, Wood Matthew J, Faddul Farah, Musbahi Omar, Bajracharya Abhijit, Magan Ahmed A, Jayadev Chethan, Giannoudis Peter V
Orthopaedic Surgery Imperial College London.
Joint Reconstruction Unit Royal National Orthopaedic Hospital NHS Trust.
Orthop Rev (Pavia). 2024 Jan 6;16:91507. doi: 10.52965/001c.91507. eCollection 2024.
The number of total knee replacements (TKRs) performed per year has been increasing annually and it is estimated that by 2030 demand would reach 3.48 million procedures per year in the United States Of America. The prevalence of periprosthetic fractures (PPFs) around TKRs has followed this trend with incidences ranging from 0.3% to 3.5%. Distal femoral PPFs are associated with significant morbidity and mortality. When there is sufficient bone stock in the distal femur and a fracture pattern conducive to fixation, locking compression plating (LCP) and retrograde intramedullary nailing (RIMN) are commonly used fixation strategies. Conversely, in situations with loosening and deficient bone stock, a salvage procedure such as a distal femoral replacement is recognized as an alternative. This meta-analysis investigates the rates of non-union, re-operation, infection, and mortality for LCPs and RIMNs when performed for distal femoral PPFs fractures around TKRs.
A search was conducted to identify articles relevant to the management of distal femoral PPFs around TKRs in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles meeting the inclusion criteria were then assessed for methodological quality using the methodological items for non-randomised studies (MINORS) criteria. Articles were reviewed, and data were compiled into tables for analysis.
10 articles met the inclusion criteria, reporting on 528 PPFs. The overall incidence of complications was: non-union 9.4%, re-operation 12.9%, infection 2.4%, and mortality 5.5%. This meta-analysis found no significant differences between RIMN and LCP in rates of non-union (9.2% vs 9.6%) re-operation (15.1% vs 11.3%), infection (2.1% vs 2.6%), and mortality (6.0% vs 5.2%), respectively.
This meta-analysis demonstrated no significant difference in rates of non-union, re-operation, infection, and mortality between RIMN and LCP and both remain valid surgical treatment options.
每年进行的全膝关节置换术（TKR）数量一直在逐年增加，据估计，到2030年，美国每年的需求将达到348万例手术。TKR周围假体周围骨折（PPF）的患病率也呈上升趋势，发生率在0.3%至3.5%之间。股骨远端PPF与显著的发病率和死亡率相关。当股骨远端有足够的骨量且骨折类型有利于固定时，锁定加压钢板（LCP）和逆行髓内钉（RIMN）是常用的固定策略。相反，在假体松动和骨量不足的情况下，挽救手术如股骨远端置换被认为是一种替代方法。本荟萃分析调查了LCP和RIMN用于TKR周围股骨远端PPF骨折时的不愈合、再次手术、感染和死亡率。
按照系统评价和荟萃分析的首选报告项目（PRISMA）清单进行检索，以确定与TKR周围股骨远端PPF管理相关的文章。然后使用非随机研究方法学项目（MINORS）标准对符合纳入标准的文章进行方法学质量评估。对文章进行综述，并将数据整理成表格进行分析。
10篇文章符合纳入标准，报道了528例PPF。并发症的总体发生率为：不愈合9.4%，再次手术12.9%，感染2.4%，死亡率5.5%。本荟萃分析发现，RIMN和LCP在不愈合率（9.2%对9.6%）、再次手术率（15.1%对11.3%）、感染率（2.1%对2.6%）和死亡率（6.0%对5.2%）方面分别无显著差异。
本荟萃分析表明，RIMN和LCP在不愈合、再次手术、感染和死亡率方面无显著差异，两者仍然是有效的手术治疗选择。
