Magu Narender Kumar, Gogna Paritosh, Singh Amanpreet, Singla Rohit, Rohilla Rajesh, Batra Amit, Mukhopadhyay Reetadyuti
Department of Orthopaedics and Rehabilitation, PGIMS, 2/11-J (UH) Medical Enclave, Rohtak, Haryana, 24001, India.
J Orthop Traumatol. 2014 Sep;15(3):173-9. doi: 10.1007/s10195-014-0297-8. Epub 2014 May 31.
Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.
We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25-60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5-22 years) who met the inclusion criteria formed the study cohort. Matta's criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d'Aubigné and Postel score.
Anatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d'Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.
Anatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.
(Level 4) Retrospective case series.
后壁骨折是所有髋臼骨折中最常见的类型，对于移位骨折采用解剖复位和稳定的内固定治疗是普遍共识。尽管已有此类研究的早期和中期结果，但很少有关于长期结果的报道。本研究旨在评估后壁髋臼骨折患者的长期功能和影像学结果，并确定可能对最终满意结果产生不利影响的因素。
我们回顾性分析了接受后壁髋臼骨折切开复位内固定术（ORIF）患者的医院记录。25例患者（20例男性，5例女性），包括1例双侧后壁骨折患者，平均年龄41.28±7.16岁（范围25 - 60岁），平均随访12.92±6.36年（范围5 - 22年），符合纳入标准的患者组成研究队列。采用Matta标准对术后复位情况和最终影像学结果进行分级。末次随访时的功能结果根据d'Aubigné和Postel评分进行评估。
22髋实现了解剖复位，4髋复位欠佳，无复位差的情况。末次随访时的影像学结果显示，10髋为优，8髋为良，5髋为可，3髋为差。最终的d'Aubigné和Postel评分中，14髋为优，6髋为良，3髋为可，3髋为差。解剖复位的患者在功能和影像学方面有良好的长期结果。然而，下肢合并伤的存在和体重指数（BMI）>25对最终功能结果产生了不利影响。3例患者出现股骨头坏死，2例出现异位骨化，1例出现莫雷尔 - 拉瓦利损伤。1例患者术后出现坐骨神经麻痹，术后6周恢复。
术后解剖复位在长期随访中可带来最佳的功能和影像学结果；然而，后壁髋臼骨折患者下肢合并伤的存在和BMI>25对最终满意结果产生不利影响。
（4级）回顾性病例系列。
