2013AAOS：全髋置换治疗切开复位内固定术后失败的髋臼骨折

引言：目前很少有研究探讨过髋臼骨折类型与是否需要进行二期全髋关节置换之间的关系。本研究旨在确定需要二期全髋关节置换比例较高的髋臼骨折类型。
方法：回顾性收集2000年至2010年之间于一家三级创伤中心接受处置的髋臼骨折病例的影像和临床资料，并对这些骨折进行分型。并将这些相关资料与接受二期全髋关节置换的病例资料进行对比。记录所有病例的影像学和临床检查资料。
结果：共检索到543例髋臼骨折病例，按Judet标准对这些骨折进行分型。其中有49例最终接受二期全髋关节置换。接受全髋关节置换的病例中，骨折涉及髋臼后壁者（后壁骨折、横型加后壁骨折、后柱加后壁骨折）有38%病例接受全髋关节置换，占所有最终接受全髋关节置换病例的一半以上。骨折涉及髋臼前壁者最终有33%的病例接受全髋关节置换。我们也记录了从初始损伤到全髋关节置换的时间。受伤时年龄在50岁以上的患者有9.5%接受了全髋关节置换，51-65岁的比例是7.5%，而65岁以上者为8.4%。18-50岁之间的患者从受伤到全髋关节置换的时间平均为17个月，51-65岁者平均为14个月，而65岁以上者平均为9个月。
讨论和结论：本研究我们确定了一组因髋臼骨折在骨折治疗过程中需要早期行二期全髋关节置换的病例。尽管三组病例接受二期全髋关节置换的比例相似，但从初始损伤到二期全髋关节置换的时间并不相同，表现为随患者年龄增加二期全髋置换的时间随之延迟的趋势。65岁以上年龄段的患者二期全髋关节置换距初始损伤的时间在1年之内，因此对于该年龄段的病例，尤其是骨折涉及髋臼前/后壁者，可以考虑予以一期全髋关节置换。总体而言，髋臼骨折病例最终需要全髋关节置换的比例较高。但在初始损伤发生后很难确定哪些病例需要予以全髋关节置换，目前也无充分资料表明骨折类型和/或患者年龄与需要二期全髋关节置换之间关系。据我们所知，本研究为第一次进行的类似研究。
与髋臼相关的拓展阅读：

• J Arthroplasty：髋关节置换联合Chiari骨盆截骨重建髋臼
• 髋关节后脱位合并髋臼后壁骨折长期疗效的决定因素
• 关节镜下股骨头颈成形术有效治疗股骨髋臼撞击症
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Total Hip Arthroplasty for Failed Treatment of Acetabular Fractures with Prior Open Reduction and Internal Fixation
INTRODUCTION
Few reports have addressed the relationship between acetabular fracture pattern and the need for secondary total hip arthroplasty (THA). The aim of our paper is to try and identify a subset of acetabular fractures that have a high incidence of secondary THA.
METHODS
Radiographs and hospital charts of all patients with an acetabulum fracture at a level 1 trauma center were retrospectively reviewed and fractures classified from 2000-2010. These were cross-referenced with those who received a secondary total hip arthroplasty. Radiographic and clinical exam findings were recorded.
RESULTS
A total of 543 acetabulum fractures were identified and classified based on the Judet system. Forty-nine of those 543 patients underwent secondary THA. Posterior wall variants (posterior wall, transverse posterior wall, posterior column/posterior wall) received a secondary THA 38% of the time, and accounted for over half of the secondary THAs. Fractures involving the anterior wall received a secondary THA 33% of the time. Time from initial injury to secondary THA was also collected. The percentages of patients under 50 years old needing a secondary THA was 9.5%, followed by 7.5% in the 51-65 year age group and 8.4% in the over 65 population. The average time to THA in the 18-50 year age group was 17 months, 51-65 years old was 14 months and 65+ years was nine months.
DISCUSSION AND CONCLUSION
We identified a cohort of patients who required secondary THA early in their fracture management. While the percentage of patients receiving a secondary THA were similar, the average time to secondary THA within those groups were not and there was a noticeable downward trend in time to THA as patient age increased. In the 65+ age group, the time to secondary THA was well under one year. Consideration for THA as an initial treatment should be given to this patient demographic, particularly in those with wall fractures. Ultimately, there are a percentage of patients who will require THA following an acetabulum fracture. Identifying which patient, however, is difficult and there is little information correlating fracture type and/or age with the need for secondary THA. To our knowledge, this is the first study of its type.