R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Orthop Trauma. 2018 Jul;32(7):e251-e257. doi: 10.1097/BOT.0000000000001163.
To identify the risk factors for early reoperation after operative fixation of acetabular fractures.
Retrospective evaluation.
Level I Trauma Center.
Seven hundred ninety-one patients with displaced acetabular fractures treated with open reduction and internal fixation (ORIF) from 2006 to 2015. Average follow-up was 52 weeks.
Early reoperation after acetabular ORIF, defined as secondary procedure for infection or revision within 3 years of initial operation.
Fifty-six (7%) patients underwent irrigation and debridement for infection and wound complications. Four associated risk factors identified were length of stay in the intensive care unit, pelvic embolization, operative time, and time delay between injury and surgical fixation. Sixty-two (8%) patients underwent early revision, including 45 conversions to total hip arthroplasty, 10 revision ORIF, 6 fixation device removals because of concern for joint penetration (2 acutely and 4 > 6 months after surgery), and 1 stabilization procedure. Three risk factors associated with early revision were hip dislocation, articular comminution, and concomitant femoral head or neck injury. Combined injuries to the pelvic ring and acetabulum, fracture pattern, marginal impaction, and body mass index had no significant effect on early revision surgery.
Risk factors for early reoperation after operative fixation of acetabular fractures differed based on the reason for return to the operating room. Infection was more likely to occur in patients who had prolonged stays in the intensive care unit, had prolonged operative times, were embolized, or experienced delay in time to fixation. Revision was more likely with hip dislocation, articular comminution, femoral head or neck fracture, and advancing age.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定髋臼骨折切开复位内固定术后早期再次手术的危险因素。
回顾性评估。
一级创伤中心。
2006 年至 2015 年期间，791 例移位髋臼骨折患者接受切开复位内固定术（ORIF）治疗。平均随访时间为 52 周。
髋臼 ORIF 术后早期再次手术，定义为初始手术后 3 年内因感染或翻修而进行的二次手术。
56 例（7%）患者因感染和伤口并发症行灌洗清创术。确定的 4 个相关危险因素为：重症监护病房住院时间、骨盆栓塞、手术时间和受伤至手术固定的时间延迟。62 例（8%）患者行早期翻修术，其中 45 例转为全髋关节置换术，10 例行翻修 ORIF，6 例因担心关节穿透而取出固定装置（2 例在术后急性，4 例在术后>6 个月），1 例行稳定术。与早期翻修相关的 3 个危险因素为髋关节脱位、关节粉碎和股骨头或颈部骨折。骨盆环和髋臼的联合损伤、骨折模式、边缘嵌插和体重指数对早期翻修手术无显著影响。
髋臼骨折切开复位内固定术后再次手术的危险因素因返回手术室的原因而异。感染更可能发生在重症监护病房住院时间延长、手术时间延长、栓塞或固定时间延迟的患者中。髋关节脱位、关节粉碎、股骨头或颈部骨折和年龄增长更可能导致翻修。
预后 III 级。请参阅作者指南以获取证据水平的完整描述。
