Tosounidis G, Culemann U, Bauer M, Holstein J H, Garcia P, Kurowski R, Pizanis A, Aghayev E, Pohlemann T
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland.
Unfallchirurg. 2011 Aug;114(8):655-62. doi: 10.1007/s00113-011-2021-y.
The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented.
本研究的目的是分析老年髋臼骨折患者的临床结局及髋关节炎的发生率。由于老年人骨质较差，即使是低能量创伤也可能导致髋臼骨折。髋臼的解剖重建对于实现潜在的髋关节置换术的足够稳定性也是必要的。到目前为止，关于老年髋臼骨折结局的信息非常有限。在6年期间（2001 - 2006年），48例60岁以上的髋臼骨折患者入住我科。39例患者接受了手术治疗，9例患者接受了非手术治疗。对29例接受手术治疗的患者进行了随访。其中19例除临床检查外，还使用EQ - 5D、SF - 12和Merle d'Aubigné问卷进行了评估。另外10例手术患者仅使用问卷进行了检查。在随访的29例患者中，5例在切开复位内固定（ORIF）后因创伤后继发性髋关节炎接受了全髋关节置换术。手术侧髋关节的活动范围与未手术的对侧相当。然而，与未手术的对侧相比，手术侧的内旋发现略有下降。与接受二期髋关节置换术的患者相比，接受ORIF治疗的患者Merle d'Aubigné评分、SF - 12身体和精神评分成分以及生活质量更好。关于老年髋臼骨折的不同治疗策略（ORIF与一期髋关节置换术与非手术治疗），文献数据存在冲突。我们的结果表明，ORIF是老年髋臼骨折的一种良好治疗选择。在未发生继发性髋关节炎的患者中，记录了良好的临床结局和生活质量。
