Bilekdemir Utku, Civan Osman, Cavit Ali, Özdemir Hakan
Department of Orthopaedics and Traumatology, Silifke State Hospital, Mersin-Turkey.
Department of Orthopaedics and Traumatology, Elmalı State Hospital, Antalya-Turkey.
Ulus Travma Acil Cerrahi Derg. 2020 Mar;26(2):265-273. doi: 10.14744/tjtes.2019.88472.
This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis.
Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19-67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2-8 years) were performed at least for two years were included in this study.
Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3%of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher's p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461).
It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.
本研究旨在评估手术治疗髋臼骨折的手术方法、并发症、临床及影像学表现，并确定影响预后的参数。
在1994年至2014年间接受手术治疗且诊断为移位髋臼骨折的144例患者中，本研究纳入了103例患者，其中男性75例，女性28例，平均年龄36.3岁（范围19 - 67岁），这些患者至少进行了两年的临床和影像学随访（平均：34个月，范围2 - 8年）。
64%的患者临床结果为优至良，36%的患者为中至差；而影像学结果优至良的患者占57.3%，中至差的患者占42.7%。出现以下并发症之一会使临床结果恶化（卡方检验p<0.001）：形成机械性阻挡、复杂骨折（卡方检验p = 0.023）、创伤与手术间隔时间延长（p = 0.039）、手术时间超过6小时（卡方检验p<0.001）、关节内台阶超过3mm（费舍尔检验p = 0.033）、缺血性坏死（p<0.001）、关节炎（p = 0.006）和异位骨化（p = 0.007）（卡方检验p<0.001）。患者年龄对临床结果无影响（p = 0.461）。
发现影响髋臼骨折预后的三个主要参数如下：骨折类型、手术时间和复位质量。创伤与手术间隔时间间接影响结果。缺血性坏死、异位骨化和关节炎可能仅对长期结果产生负面影响。
