Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older
Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older
复制标题
DOI：
10.1016/j.arth.2016.06.006
复制
发表时间：
2017-01-01
影响因子：
3.5
通讯作者：
Karunakar, Madhav A.
中科院分区：
文献类型：
--
作者：
Hart, Gavin P.;Kneisl, Jeffrey S.;Karunakar, Madhav A.
背景：老年人股骨远端骨折的理想治疗方法尚不清楚。急性关节置换术在理论上具有更早活动的优势。我们比较了接受切开复位内固定(ORIF)和股骨远端置换术(DFR)治疗股骨远端关节内粉碎性骨折的70岁以上患者的疗效。结果：本研究共纳入38例患者，其中10例接受DFR治疗，28例接受ORIF治疗。两组患者的平均年龄均为82岁。两组间在合并症及损伤机制方面无明显差异。再手术率ORIF组为11%，DFR组为10%。在ORIF组，骨折平均愈合时间为24周，骨不连发生率为18%。在DFR队列中，23%的ORIF组有轮椅依赖，而在DFR队列中没有轮椅依赖，尽管在统计学上没有显著意义。两组患者在全原因再手术、1年后的生存情况或对活动装置的需求以及1年内死亡率方面的差异没有统计学意义。结论：近1/5的70岁以上的患者在股骨远端关节内骨折的ORIF术后发生骨不连。随访1年，DFR组所有患者均能行走，而ORIF组每4例患者中就有1例被限制在轮椅上。(C)2016 Elsevier Inc.保留所有权利。
Background: The ideal management of distal femur fractures in the elderly is unclear. Acute arthroplasty has the theoretical advantage of earlier mobilization. We examined the outcomes of patients 70 years and older who underwent open reduction internal fixation (ORIF) vs distal femoral replacement (DFR) for comminuted, intra-articular distal femur fractures.Methods: A retrospective review of patients with AO/OTA classification 33C distal femur fractures treated with either ORIF or DFR was performed. Outcomes including all-cause reoperation, length of stay, fracture union, postoperative complications, use of ambulatory device and living situation at 1 year, and mortality were evaluated.Results: The study cohort included 38 patients: 10 underwent DFR and 28 ORIF. Mean patient age for both cohorts was 82 years. No difference in comorbidities or mechanism of injury was found between groups. The incidence of reoperation was 11% in the ORIF group and 10% in the DFR group. In the ORIF group, the average time to fracture union was 24 weeks, with a nonunion incidence of 18%. Twenty-three percent of ORIF group were wheelchair dependent vs none in the DFR cohort, although not statistically significant. Differences between the groups with respect to all-cause reoperation, living situation or need for ambulatory device at 1 year, and 1-year mortality did not reach statistical significance.Conclusion: Nearly 1 in 5 patients older than 70 years developed a nonunion after ORIF of an intra-articular distal femur fracture. At 1-year follow-up, all patients in DFR group were ambulatory while 1 in 4 in the ORIF group were wheelchair bound. (C) 2016 Elsevier Inc. All rights reserved.