采用TIMI入路对老年人群髋臼骨折进行内固定——一项前瞻性研究的中期结果
Internal fixation of acetabular fractures in an older population using the TIMI approach - Midterm results of a prospective study.
作者信息
Aigner Rene, Hellige Ralf, Knippel Sabine, Oberkircher Ludwig, Ruchholtz Steffen, Buecking Benjamin
机构信息
Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany.
Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Location Marburg, Germany.
出版信息
Injury. 2017 Apr;48(4):890-896. doi: 10.1016/j.injury.2017.02.001. Epub 2017 Feb 3.
INTRODUCTION
The incidence of geriatric acetabular fractures continues to increase due to demographic changes. In the elderly, anterior column fractures are common, and standard approaches are associated with a considerable risk for surgery-associated complications. Therefore, a minimally invasive approach was developed in our department. The aim of this study was to examine early and mid-term results regarding the use of this novel two-incision minimally invasive (TIMI) approach in patients aged over 55 years with acetabular fractures.
METHODS
From July 2007 to April 2014, 47 patients aged over 55 years were treated via the TIMI approach; these patients were included in the present prospective study. The patients' characteristics, data, and early phase of care were assessed during acute care. A radiological evaluation comprised pre- and postoperative CT scans and x-rays, including Judet views at follow-up. Follow-up examinations were performed after 6 and 24 months and comprised a clinical and radiological examination and an evaluation of hip function (Harris Hip Score) and health-related quality of life (EQ-5D).
RESULTS
The mean age of the patients was 74±11years, with a gender ratio of 35/12 (m/f). The average operation time was 93±30min, and perioperative blood loss amounted to 858±463ml. In total, five (11%) complications associated with the operative procedure occurred, and revision surgery was necessary in three patients. We observed no wound infections, abdominal wall hernias or cases of heterotopic ossification in our sample. The Harris Hip Score at six months after surgery was 81, and it slightly improved to 84 after 24 months. The mean EQ5D index was 0.91 at six months after surgery and 0.92 at 24 months after surgery.
CONCLUSION
The TIMI approach represents a valuable alternative to the ilioinguinal and modified Stoppa approach for the treatment of acetabular fractures located in the anterior column, which are often observed in geriatric patients.
LEVEL OF EVIDENCE
Therapeutic Level II (Prospective cohort study).
引言
由于人口结构变化，老年髋臼骨折的发病率持续上升。在老年人中，前柱骨折很常见，标准手术方法与手术相关并发症的风险相当高。因此，我们科室开发了一种微创方法。本研究的目的是探讨在55岁以上髋臼骨折患者中使用这种新型双切口微创（TIMI）方法的早期和中期结果。
方法
2007年7月至2014年4月，47例55岁以上患者采用TIMI方法治疗；这些患者被纳入本前瞻性研究。在急性护理期间评估患者的特征、数据和护理早期阶段。放射学评估包括术前和术后CT扫描及X线检查，包括随访时的Judet位片。在6个月和24个月后进行随访检查，包括临床和放射学检查以及髋关节功能（Harris髋关节评分）和健康相关生活质量（EQ-5D）评估。
结果
患者的平均年龄为74±11岁，性别比为35/12（男/女）。平均手术时间为93±30分钟，围手术期失血量为858±463毫升。总共发生了5例（11%）与手术相关的并发症，3例患者需要进行翻修手术。在我们的样本中未观察到伤口感染、腹壁疝或异位骨化病例。术后6个月的Harris髋关节评分为81分，24个月后略有提高至84分。术后6个月的平均EQ5D指数为0.91，术后24个月为0.92。
结论
对于老年患者中常见的位于前柱的髋臼骨折，TIMI方法是髂腹股沟和改良Stoppa方法的一种有价值的替代方法。
证据水平
治疗性II级（前瞻性队列研究）。
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