Firoozabadi Reza, Spitler Clay, Schlepp Calvin, Hamilton Benjamin, Agel Julie, Routt Milton Chip, Tornetta Paul
*Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA; †University of Mississippi, Jackson, MS; ‡University of Washington, Seattle, WA; §Case Western School of Medicine, Cleveland, OH; ‖Harborview Medical Center, University of Washington, Seattle, WA; ¶University of Texas, Houston, TX; and **Boston University Medical Center, Boston, MA.
J Orthop Trauma. 2015 Oct;29(10):465-9. doi: 10.1097/BOT.0000000000000354.
To determine if the radiographic parameters of femoral head coverage by the intact posterior wall, acetabular version, and location of the fracture or a history of dislocation were determinates of hip stability in patients with posterior wall acetabular fractures.
Retrospective review.
Level I trauma hospital.
One hundred eighty-five consecutive patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures.
Patients underwent dynamic stress fluoroscopic examination under general anesthesia to determine hip stability.
A number of radiographic measurements were performed, and an examination under anesthesia served as a standard to compare stable versus unstable hips.
Examination under anesthesia (EUA) determined 116 hips to be stable and 22 hips as unstable. Moed and Keith method of wall size measurements and cranial exit point of fracture was statistically different between stable and unstable hips. Twenty-three percent of the unstable hips had wall sizes less than 20%. Average cranial exit point of fracture from dome was 5.0 mm in the unstable group and 9.5 mm in the stable group, and fractures that extend into the dome demonstrate a statistically significant increase in hip instability.
Determination of hip stability can be challenging in patients with posterior wall acetabular fractures. Our data suggest that the location of the exit point of the fracture in relation to the dome of the acetabulum is a radiographic marker that can be used to aid physician in determining stability, and wall sizes less than 20% is not a reliable indicator of stability.
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定完整后壁对股骨头的覆盖、髋臼旋转角度、骨折位置或脱位病史等影像学参数是否为后壁髋臼骨折患者髋关节稳定性的决定因素。
回顾性研究。
一级创伤医院。
185例连续的孤立性单侧后壁（OTA 62-A1）髋臼骨折患者。
患者在全身麻醉下接受动态应力透视检查以确定髋关节稳定性。
进行了多项影像学测量，并以麻醉下检查作为比较稳定和不稳定髋关节的标准。
麻醉下检查（EUA）确定116例髋关节稳定，22例髋关节不稳定。稳定和不稳定髋关节之间，Moed和Keith测量后壁大小的方法以及骨折的颅侧出口点存在统计学差异。23%的不稳定髋关节后壁大小小于20%。不稳定组骨折距髋臼顶的平均颅侧出口点为5.0 mm，稳定组为9.5 mm，延伸至髋臼顶的骨折显示髋关节不稳定有统计学意义的增加。
后壁髋臼骨折患者的髋关节稳定性判定可能具有挑战性。我们的数据表明，骨折出口点相对于髋臼顶的位置是一种影像学标志物，可用于帮助医生确定稳定性，后壁大小小于20%并非稳定性的可靠指标。
诊断性二级。有关证据水平的完整描述，请参阅作者须知。
