Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen.
Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Universität München (LMU).
Z Orthop Unfall. 2021 Jun;159(3):298-303. doi: 10.1055/a-1085-2717. Epub 2020 Feb 3.
Fractures of the posterior wall of the acetabulum occur in a frequency of 25 - 30%. Multifragmentary fractures involving 40 - 50% of the acetabular surface, the quality of reduction as well as involvement of cartilage and acetabular labrum are considered to have an impact on the development of a reduced posterior stability of the hip joint. This results in a shift of the main weight bearing area with development of a posttraumatic osteoarthritis. In the presented case, a 42-year old male patient was operated on 18 years ago due to a posterior acetabular wall fracture. Retrospectively, one of the screws was located partially intraarticular. However, the patient was asymptomatic over the 18-year period. The first consultation was due to unspecific symptoms of osteoarthritis of the right hip joint especially during flexion and external rotation. Due to only mild radiological signs of osteoarthritis, we indicated only the removal of the intraarticular screw. The symptoms postoperatively switched to a feeling of instability, so a total hip arthroplasty was performed. Since the operation, the patient is asymptomatic regarding the hip joint. The intraarticular screw seemed to stabilize the hip joint. This case demonstrates the importance of a good posterior guidance for the stability of the hip joint on one hand. On the other hand, it demonstrates the minor stress load of the posterior acetabular region, especially after fracture of the posterior wall. Therefore, a good posterior guidance should be one major aim of treatment of posterior acetabular wall fractures.
髋臼后壁骨折的发生率为 25% 至 30%。涉及髋臼表面 40% 至 50%、复位质量以及软骨和髋臼盂唇受累的多片段骨折被认为会影响髋关节后侧稳定性的恢复。这会导致主要承重区域移位，进而发展为创伤后骨关节炎。在本例中，一名 42 岁的男性患者 18 年前因髋臼后壁骨折接受了手术。回顾性研究发现，其中一个螺钉部分位于关节内。然而，在 18 年的时间里，患者没有任何症状。首次就诊是由于右髋关节的非特异性骨关节炎症状，尤其是在弯曲和外旋时。由于仅存在轻度的骨关节炎放射学征象，我们仅建议取出关节内螺钉。术后症状转为不稳定感，因此进行了全髋关节置换术。术后，患者髋关节无症状。关节内螺钉似乎稳定了髋关节。该病例一方面表明了髋关节稳定性需要良好的后向引导，另一方面也表明了髋臼后区的应力负荷较小，尤其是在后壁骨折后。因此，良好的后向引导应该是治疗髋臼后壁骨折的主要目标之一。
