Dawson Peter, Dunne Lisa, Raza Hasnain, Quinn Mark, Leonard Michael
The National Centre for the Treatment of Pelvic and Acetabular Fractures, Tallaght University Hospital, Dublin, Ireland.
Eur J Orthop Surg Traumatol. 2019 Jul;29(5):1049-1054. doi: 10.1007/s00590-019-02406-6. Epub 2019 Feb 22.
Acetabular fractures are associated with damage to the femoral head, acetabular cartilage and labrum and possible disruption of the femoral head blood supply. Treatment aims to provide the best opportunity for restoration of joint function and to prevent long-term complications. Surgical intervention, in the form of open reduction and internal fixation (ORIF), is often required. Where post-traumatic osteoarthritis develops after ORIF, total hip arthroplasty (THA) is often required. Our aim here has been to identify and highlight our experience with the key technical points associated with successful outcomes for THA in this setting.
A single-centre retrospective review of patients with acetabular fractures treated with ORIF and subsequent THA over a 4-year period was undertaken. Demographics, mechanism of injury, complications, interval time between surgeries, intra-operative outcomes and post-operative outcomes were recorded. Particular emphasis is made to describe standard pre-operative and intra-operative protocols.
Twenty-five patients were identified, with a mean age of 51.1 years at time of first ORIF. 60% presented following RTA. 80% of fractures involved the posterior wall or column. Meantime to eventual THA was 2.3 years. Mean THA duration was 1.52 h, with mean intra-operative blood loss and length of stay of 585 ml and 5 days, respectively. 24% required intra-operative removal of metal, with only one patient suffering a complication post-THA.
Acceptable post-operative outcomes were demonstrated throughout the case series. In describing the pre-operative work up, intra-operative findings and intra-operative and post-operative complications encountered, common important technical points associated with a successful surgical strategy are described. Furthermore, potential pitfalls that may be encountered can be anticipated.
髋臼骨折常伴有股骨头、髋臼软骨和盂唇损伤，以及股骨头血供可能中断。治疗旨在为恢复关节功能提供最佳机会，并预防长期并发症。通常需要采用切开复位内固定术（ORIF）进行手术干预。如果在ORIF术后发生创伤后骨关节炎，则通常需要进行全髋关节置换术（THA）。我们的目的是识别并突出我们在这种情况下THA成功结果相关关键技术要点方面的经验。
对4年内接受ORIF及随后THA治疗的髋臼骨折患者进行单中心回顾性研究。记录人口统计学资料、损伤机制、并发症、两次手术之间的间隔时间、术中结果和术后结果。特别着重描述标准的术前和术中方案。
共纳入25例患者，首次ORIF时的平均年龄为51.1岁。60%的患者因道路交通事故就诊。80%的骨折累及后壁或后柱。至最终进行THA的平均时间为2.3年。THA的平均时长为1.52小时，术中平均失血量和住院时间分别为585毫升和5天。24%的患者术中需要取出金属植入物，只有1例患者在THA术后出现并发症。
整个病例系列均显示出可接受的术后结果。通过描述术前检查、术中发现以及术中及术后遇到的并发症，阐述了与成功手术策略相关的常见重要技术要点。此外，还可以预见可能遇到的潜在陷阱。
