Song Liming, Zhang Tieliang, Yu Jianhua, Ren Kaijing
Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):968-71.
To investigate the causes and managements of acetabular fracture during primary total hip arthroplasty (THA).
Between May 2005 and July 2008, 9 patients (9 hips) suffered from acetabular fractures during primary THA. There were 1 male and 8 females with an average age of 63.3 years (range, 41-73 years), including 4 cases of developmental dysplasia of the hip, 2 cases of rheumatoid arthritis, 1 case of old femoral neck fracture, 1 case of avascular necrosis of femoral head, and 1 case of ankylosing spondylitis. Three left hips and 6 right hips were involved. The preoperative Harris score was 40.4 +/- 2.9. All the patients underwent cementless THA. Among nine acetabular fractures, 8 fractures were stable (2 anterior wall fractures and 6 posterior wall fractures), which were fixed by additional augmentation screws in 7 cases and accepted no special treatment in 1 case; 1 fracture was unstable (posterior wall fracture with posterior column incomplete fracture), which was treated by bone grafting and additional screws.
The postoperative X-ray films showed that the position of the prosthesis were favorable. All incisions healed by first intention without early complication. Nine patients were followed up 1-4 years (mean, 2 years and 7 months). The Harris score was 87.8 +/- 3.9 at last follow-up, showing significant difference when compared with the preoperative score (t = 44.904, P = 0.000). The X-ray films showed fracture healing at 8 weeks. No loosening occurred.
When primary THA is performed, the preoperative X-ray film should be studied and measured carefully, operation should be accurate and violence should be avoided. The diameter of the acetabular component should be equal to the diameter of a drill or not larger than 2 mm. In patients with severe osteoporosis, the diameter of the acetabular components should be the same diameter as a drill and additional screws are used to fix, or cemented cup is used. Once an acetabular fracture occurs during the primary THA, additional screw or bone grafting with additional screws should be chosen according to the fracture type and stability, and good clinical results can be expected.
探讨初次全髋关节置换术（THA）中髋臼骨折的原因及处理方法。
2005年5月至2008年7月期间，9例（9髋）患者在初次THA术中发生髋臼骨折。其中男性1例，女性8例，平均年龄63.3岁（范围41 - 73岁），包括髋关节发育不良4例、类风湿关节炎2例、陈旧性股骨颈骨折1例、股骨头缺血性坏死1例、强直性脊柱炎1例。涉及左侧髋关节3例，右侧髋关节6例。术前Harris评分为40.4±2.9。所有患者均接受非骨水泥型THA。9例髋臼骨折中，8例骨折稳定（2例前壁骨折，6例后壁骨折），7例通过附加增强螺钉固定，1例未接受特殊处理；1例骨折不稳定（后壁骨折合并后柱不完全骨折），采用植骨并附加螺钉治疗。
术后X线片显示假体位置良好。所有切口一期愈合，无早期并发症。9例患者随访1 - 4年（平均2年7个月）。末次随访时Harris评分为87.8±3.9，与术前评分相比差异有统计学意义（t = 44.904，P = 0.000）。X线片显示骨折在8周时愈合。无松动发生。
进行初次THA时，应仔细研究和测量术前X线片，手术操作应精确，避免暴力。髋臼假体直径应与钻头直径相等或不大于2 mm。对于严重骨质疏松患者，髋臼假体直径应与钻头直径相同，并使用附加螺钉固定，或使用骨水泥杯。初次THA术中一旦发生髋臼骨折，应根据骨折类型和稳定性选择附加螺钉或植骨并附加螺钉治疗，有望获得良好的临床效果。
