Herath S C, Rollmann M F R, Histing T, Holstein J H, Pohlemann T
Klink für Unfall-, Hand und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
Chirurg. 2017 Feb;88(2):105-109. doi: 10.1007/s00104-016-0340-9.
Periprosthetic acetabular fractures in geriatric patients are rare injuries; however, the incidence is increasing because of the current demographic developments. For diagnosis of periprosthetic acetabular fractures, conventional X‑ray images are regularly complemented by computed tomography (CT). For exclusion of loosening of the prosthesis more advanced techniques, such as single photon emission CT (SPECT/CT) are applied. In addition to classification of periprosthetic acetabular fractures by the traditional system of Letournel there are several other classification systems, which take into account the etiology of the fracture and the stability of the prosthesis. While, under certain circumstances conservative treatment of periprosthetic acetabular fractures is possible, operative treatment often requires extensive surgical procedures to restore the stability of the acetabulum as a support for the cup of the prosthesis. Besides the traditional techniques of acetabular osteosynthesis, special revision systems, augmentations and allografts are used for the reconstruction of periprosthetic acetabular fractures. To determine a therapeutic regimen patient-specific preconditions as well as fracture pattern and type of prosthesis need to be taken into account. In the literature there are several algorithms, which are aimed at supporting the attending physician in making the correct decision for the treatment of periprosthetic acetabular fractures. In cases of periprosthetic acetabular fractures even experienced surgeons are faced with great challenges. Thus, treatment should be carried out in specialized centers.
老年患者的髋臼周围骨折是罕见的损伤；然而，由于当前的人口发展趋势，其发病率正在上升。对于髋臼周围骨折的诊断，传统X线图像通常由计算机断层扫描（CT）补充。为排除假体松动，会应用更先进的技术，如单光子发射CT（SPECT/CT）。除了通过传统的勒图尔内尔系统对髋臼周围骨折进行分类外，还有其他几种分类系统，这些系统考虑了骨折的病因和假体的稳定性。虽然在某些情况下，髋臼周围骨折的保守治疗是可行的，但手术治疗通常需要广泛的外科手术来恢复髋臼的稳定性，以支撑假体杯。除了髋臼骨合成的传统技术外，特殊的翻修系统、增强材料和同种异体移植物也用于髋臼周围骨折的重建。为确定治疗方案，需要考虑患者的具体情况以及骨折类型和假体类型。文献中有几种算法，旨在支持主治医生对髋臼周围骨折的治疗做出正确决策。在髋臼周围骨折的病例中，即使是经验丰富的外科医生也面临巨大挑战。因此，治疗应在专业中心进行。
