Simon Paul, von Roth Philipp, Perka Carsten
Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany.
Int Orthop. 2015 Oct;39(10):1995-2003. doi: 10.1007/s00264-015-2968-3. Epub 2015 Aug 30.
Periprosthetic fractures of the acetabulum represent a rare incident in primary and revision total hip arthroplasty. The management of these fractures can be challenging. At present, there are no reliable guidelines for the treatment of periprosthetic acetabular fractures. Periprosthetic acetabular fractures can occur intra-operatively, in particular during insertion of non-cemented cups or in the context of revision surgery. Post-operative causes for periprosthetic acetabular fractures are traumatic events or, more commonly, pelvic discontinuity due to severe bone loss related to osteolysis. Despite their aetiology, the main objective of surgery is to achieve a stable acetabular component and fracture. While stable fractures and implants could be treated non-operatively, unstable fractures require surgery to achieve component stability and allow appropriate biological fixation of the revision cup. Assessment of the stability plays a crucial role before determining the treatment strategy. There is a large variety of surgical techniques available for the management of these fractures. This review article outlines the epidemiology, aetiology and current classification systems, and provides a distinct diagnostic and therapeutic algorithm for the treatment of periprosthetic acetabular fractures.
髋臼假体周围骨折在初次和翻修全髋关节置换术中均为罕见事件。这些骨折的处理颇具挑战性。目前，对于假体周围髋臼骨折的治疗尚无可靠的指导方针。假体周围髋臼骨折可在术中发生，尤其是在置入非骨水泥杯时或翻修手术过程中。假体周围髋臼骨折的术后原因是创伤事件，或更常见的是由于与骨溶解相关的严重骨质流失导致的骨盆不连续。尽管病因各异，但手术的主要目标是实现髋臼假体部件和骨折的稳定。对于稳定的骨折和植入物可采用非手术治疗，而不稳定骨折则需要手术以实现部件稳定并允许翻修杯进行适当的生物学固定。在确定治疗策略之前，稳定性评估起着关键作用。有多种手术技术可用于处理这些骨折。本文综述概述了其流行病学、病因及当前的分类系统，并为假体周围髋臼骨折的治疗提供了独特的诊断和治疗方案。
