Abstract：
BACKGROUND: Vancouver B2 and B3 periprosthetic fractures (PFF) are associated with stem instability and often require a demanding stem implant revision (SR) or internal fixation (ORIF). This latter surgery is increasingly performed in the last few years instead of SR, but it is unclear which is the best treatment to manage PFF patients. The aim of this study is the compare the outcomes of B2/B3 PFF managed by either ORIF or SR, by performing a systematic review and meta-analysis of current literature.
METHODS: Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index.
RESULTS: Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39-1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45-2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46-1.12; I2 = 62%) in favor of fixation.
CONCLUSIONS: ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities.
METHODS: Cochrane Database, PubMed, Google Scholar and MEDLINE were examined to find out relevant publications dealing with the different outcomes of SR vs. ORIF in B2/B3 PFF of the hip. The effect model (EM) was calculated using Cohen´s d index.
RESULTS: Fifteen studies were included, reporting on a total of 1629 patients (564 ORIF and 1065 SR). The pooled random EM estimates for reoperation was 0.87 (95% CI, 0.39-1.96; I2 = 78%) in favor of ORIF surgery; EM for complications was 1.01 (95% CI, 0.45-2.27; I2 = 85%) without difference among procedures. The EM for transfusion was 0.72 (95% CI, 0.46-1.12; I2 = 62%) in favor of fixation.
CONCLUSIONS: ORIF and SR were both suitable and effective options in PFF patients, being associated to similar complications rates. Our results show that ORIF performance in PFF patients is associated to significantly less in blood loss, surgical time and in-hospital stay. These advantages are particularly appealing in patients with multiple comorbidities.
摘要：
背景：温哥华B2和B3假体周围骨折（PFF）与茎不稳定有关，通常需要苛刻的茎植入物翻修（SR）或内固定（ORIF）。在过去的几年中，后一种手术越来越多地进行，而不是SR，但尚不清楚哪种治疗PFF患者的最佳治疗方法。这项研究的目的是比较由ORIF或SR管理的B2/B3PFF的结果，通过对当前文献进行系统回顾和荟萃分析。
方法：Cochrane数据库，PubMed,对GoogleScholar和MEDLINE进行了检查，以找出处理SR与SR的不同结果的相关出版物。ORIF在髋部的B2/B3PFF中。使用Cohen'sd指数计算效应模型(EM)。
结果：纳入了15项研究，共报告1629例患者(564个ORIF和1065个SR)。再次手术的合并随机EM估计值为0.87（95％CI，0.39-1.96；I2=78％），有利于ORIF手术；并发症的EM为1.01（95％CI，0.45-2.27；I2=85％），程序之间无差异。输血的EM为0.72（95％CI，0.46-1.12；I2=62％），有利于固定。
结论：ORIF和SR是PFF患者的有效选择，与类似的并发症发生率有关。我们的结果表明，PFF患者的ORIF表现与明显减少失血有关，手术时间和住院时间。这些优点在具有多种合并症的患者中特别有吸引力。
方法：Cochrane数据库，PubMed,对GoogleScholar和MEDLINE进行了检查，以找出处理SR与SR的不同结果的相关出版物。ORIF在髋部的B2/B3PFF中。使用Cohen'sd指数计算效应模型(EM)。
结果：纳入了15项研究，共报告1629例患者(564个ORIF和1065个SR)。再次手术的合并随机EM估计值为0.87（95％CI，0.39-1.96；I2=78％），有利于ORIF手术；并发症的EM为1.01（95％CI，0.45-2.27；I2=85％），程序之间无差异。输血的EM为0.72（95％CI，0.46-1.12；I2=62％），有利于固定。
结论：ORIF和SR是PFF患者的有效选择，与类似的并发症发生率有关。我们的结果表明，PFF患者的ORIF表现与明显减少失血有关，手术时间和住院时间。这些优点在具有多种合并症的患者中特别有吸引力。
