Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
J Orthop Trauma. 2014 Mar;28(3):148-53. doi: 10.1097/BOT.0b013e31829c739a.
We hypothesized that open reduction and internal fixation (ORIF) of displaced acetabular fractures in geriatric patients result in a low rate of conversion to hip arthroplasty and satisfactory hip-specific validated outcome scores at medium-term follow-up.
Retrospective review.
Level I trauma center.
One hundred forty-seven consecutive patients who were 60 years or older who had acetabular fractures were treated at our center from 2001 through 2006. During this time period, fractures meeting operative criteria were treated with ORIF unless medical conditions warranted nonoperative treatment. Twenty-nine patients were lost to follow-up, 46 were deceased, and 11 declined to participate, leaving 61 potential patients for inclusion, 46 of whom were treated with ORIF (average follow-up, 4.4 years; range, 1.1-8.0 years).
Standardized telephone interviews included hip-specific questions and validated outcome measures.
Rates of conversion to hip arthroplasty and hip-specific validated outcome scores.
Among 46 patients treated with ORIF (15 others were treated nonoperatively or with percutaneous screw fixation), 28% underwent hip arthroplasty an average 2.5 years after injury (range, 0.4-5.5 years) and had an average Western Ontario and McMaster Universities Index of Osteoarthritis score of 17 (range, 0-56; n = 38). This score is similar to or better than the typical scores after elective arthroplasty for arthritis and much better than the scores for patients with established arthritis (P < 0.05). The average SF-8 Health Survey physical component score was 46.1 (range, 31-62), similar to US population norms for the geriatric age group (P > 0.20).
Few data exist regarding the treatment outcomes for geriatric acetabular fractures. It is difficult for clinicians to decide among ORIF, percutaneous fixation, acute arthroplasty, and nonoperative treatment. Our protocol of mostly ORIF showed a high 1-year mortality rate of 25% and a rate of conversion to arthroplasty after ORIF of 28%.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
我们假设老年移位髋臼骨折的切开复位内固定（ORIF）治疗后，髋关节置换的转化率较低，并且在中期随访时具有满意的髋关节特异性有效评分。
回顾性研究。
一级创伤中心。
2001 年至 2006 年期间，我们中心收治了 147 例年龄在 60 岁或以上的髋臼骨折患者。在此期间，符合手术标准的骨折采用 ORIF 治疗，除非患者的身体状况需要非手术治疗。有 29 例患者失访，46 例患者死亡，11 例患者拒绝参与，因此有 61 例潜在患者符合纳入标准，其中 46 例采用 ORIF 治疗（平均随访时间为 4.4 年；范围为 1.1-8.0 年）。
进行标准化的电话访谈，包括髋关节特异性问题和经过验证的结局测量。
髋关节置换的转化率和髋关节特异性有效评分。
在 46 例接受 ORIF 治疗的患者中（另有 15 例接受非手术治疗或经皮螺钉固定），28%的患者在受伤后平均 2.5 年（范围为 0.4-5.5 年）进行了髋关节置换，平均 Western Ontario 和 McMaster 大学骨关节炎指数评分为 17（范围为 0-56；n=38）。该评分与择期关节炎髋关节置换后的典型评分相似或更好，明显优于已确诊关节炎患者的评分（P＜0.05）。SF-8 健康调查生理成分评分平均为 46.1（范围为 31-62），与老年人群的美国人口正常值相似（P＞0.20）。
关于老年髋臼骨折的治疗结果数据很少。临床医生很难在 ORIF、经皮固定、急性关节置换和非手术治疗之间做出选择。我们的主要采用 ORIF 的方案显示出 1 年高死亡率为 25%，并且 ORIF 后髋关节置换的转化率为 28%。
治疗性 III 级。请参阅作者说明以获取完整的证据水平描述。
