Mears D C
Division of Orthopaedic Surgery, Albany Medical College, Albany, NY 12208-3479, USA.
J Am Acad Orthop Surg. 1999 Mar-Apr;7(2):128-41. doi: 10.5435/00124635-199903000-00006.
The incidence of acetabular fractures in the elderly has recently shown a marked increase due to the combination of greater longevity for the population as a whole and a relative decrease in the incidence of alcohol-related trauma in younger adults. The compromised physiologic reserve and the diminished healing capacity of the typical elderly patient have an adverse effect on the potential for a favorable clinical outcome. The presence of osteopenic bone or degenerative arthritis and the effects of previous radiation therapy to the hip and pelvis hamper diagnostic imaging and the utility of some treatment alternatives that were designed primarily for younger patients. The diverse clinical presentations include major polytrauma, minor trauma, and insufficiency fractures. An assessment of the prior health and functional status of the patient is crucial in determining the optimal therapeutic protocol. Treatment options vary according to the clinical presentation and include conservative methods, percutaneous fixation in situ, open reduction, and acute total hip arthroplasty. The feasibility of acute total hip arthroplasty rests on the use of newly developed techniques for minimally invasive stabilization of the acetabular fracture with cables and the application of morselized or structural autograft harvested from the femoral head. Whichever surgical method is chosen, the objective is rapid mobilization of the patient on a walker or crutches. Late complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, wound infection, and heterotopic bone formation.
由于总体人口寿命延长以及年轻成年人中酒精相关创伤发生率相对下降，老年髋臼骨折的发生率最近显著增加。典型老年患者生理储备受损和愈合能力下降对获得良好临床结果的可能性产生不利影响。骨质疏松性骨或退行性关节炎的存在以及先前对髋部和骨盆进行放射治疗的影响妨碍了诊断成像以及一些主要为年轻患者设计的治疗选择的效用。多样的临床表现包括严重多发伤、轻度创伤和不全骨折。评估患者先前的健康状况和功能状态对于确定最佳治疗方案至关重要。治疗选择根据临床表现而异，包括保守方法、经皮原位固定、切开复位和急性全髋关节置换术。急性全髋关节置换术的可行性取决于使用新开发的技术，即通过缆线对髋臼骨折进行微创稳定，以及应用从股骨头获取的碎骨或结构性自体骨移植。无论选择哪种手术方法，目标都是让患者尽快借助助行器或拐杖活动。非手术或手术治疗后可能发生的晚期并发症包括创伤后关节炎、骨不连、伤口感染和异位骨形成。
