与单钢板固定和股骨远端关节置换术相比,双钢板固定是治疗股骨远端假体周围骨折的合适选择。

IF 2.8 Q1 ORTHOPEDICS Bone & Joint Open Pub Date : 2024-06-12 DOI:10.1302/2633-1462.56.BJO-2023-0145.R1
Philipp Kriechling, Abigail L W Bowley, Lauren A Ross, Matthew Moran, Chloe E H Scott
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引用次数: 0

摘要

目的:本研究旨在比较双层钢板(DP)、使用外侧锁定钢板(SP)的单层钢板或股骨远端关节置换术(DFA)治疗股骨远端假体周围骨折(PDFF)的再手术率和翻修率:这项回顾性队列研究纳入了一家大学教学医院在2008年至2022年期间主要采用DP、SP或DFA治疗的所有PDFF患者。主要结果是DP、SP或DFA治疗失败后的翻修手术。次要结局指标包括再次手术、住院时间和死亡率。研究人员收集了所有基本的人口统计学信息以及相关的植入物和损伤细节。放射学分析包括骨折分类以及骺端和内侧粉碎的评估:共纳入111例PDFF(111例患者,中位年龄82岁(四分位距(IQR)75至88),86%为女性),其中32例(29%)为Su分类1,37例(34%)为Su分类2,40例(37%)为Su分类3。中位随访时间为 2.5 年(IQR 1.2 至 5.0)。DP、SP和DFA分别用于15、66和30例患者。与SP相比,接受DP治疗的患者更有可能出现干骺端粉碎(47% vs 14%; p = 0.009)、低位骨折(47% vs 11%; p = 0.009)和解剖学缩小(100% vs 71%; p = 0.030)。被选中接受DFA治疗的患者的内侧/骺端粉碎程度与接受DP治疗的患者相当。在至少两年的随访中,有11例(9.9%)因手术失败而进行了翻修手术,手术时间中位数为5个月(IQR为2至9个月):0例DP患者(0%)、9例SP患者(14%)和2例DFA患者(6.7%)(P = 0.249):结论:与 DFA 和 SP 固定相比,在骨折位置较低但有足够的远端骨质容纳锁定螺钉且存在骨骺粉碎的情况下,采用 DP 固定策略可获得同等的无翻修或再手术存活率。
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Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty.

Aims: The purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs).

Methods: All patients with PDFF primarily treated with DP, SP, or DFA between 2008 and 2022 at a university teaching hospital were included in this retrospective cohort study. The primary outcome was revision surgery for failure following DP, SP, or DFA. Secondary outcome measures included any reoperation, length of hospital stay, and mortality. All basic demographic and relevant implant and injury details were collected. Radiological analysis included fracture classification and evaluation of metaphyseal and medial comminution.

Results: A total of 111 PDFFs (111 patients, median age 82 years (interquartile range (IQR) 75 to 88), 86% female) with 32 (29%) Su classification 1, 37 (34%) Su 2, and 40 (37%) Su 3 fractures were included. The median follow-up was 2.5 years (IQR 1.2 to 5.0). DP, SP, and DFA were used in 15, 66, and 30 patients, respectively. Compared to SP, patients treated with DP were more likely to have metaphyseal comminution (47% vs 14%; p = 0.009), to be low fractures (47% vs 11%; p = 0.009), and to be anatomically reduced (100% vs 71%; p = 0.030). Patients selected for DFA displayed comparable amounts of medial/metaphyseal comminution as those who underwent DP. At a minimum follow-up of two years, revision surgery for failure was performed in 11 (9.9%) cases at a median of five months (IQR 2 to 9): 0 DP patients (0%), 9 SP (14%), and 2 DFA (6.7%) (p = 0.249).

Conclusion: Using a strategy of DP fixation in fractures, where the fracture was low but there was enough distal bone to accommodate locking screws, and where there is metaphyseal comminution, resulted in equivalent survival free from revision or reoperation compared to DFA and SP fixation.

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来源期刊
Bone & Joint Open
Bone & Joint Open ORTHOPEDICS-
CiteScore
5.10
自引率
0.00%
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0
审稿时长
8 weeks
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