Medizinische Fakultät Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
J Orthop Surg Res. 2020 Mar 23;15(1):115. doi: 10.1186/s13018-020-01611-y.
Currently available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation. Screw fixation of acetabular fractures allows patients' early full-weight bearing due to improved biomechanic stability. Can the range of motion, pain and mobility and quality of life in patients with acetabular fractures be improved by minimally invasive screw fixation, compared to conservative treatment in the long term?
Patients treated for a minimally displaced acetabular fracture, either conservatively or by closed reduction percutaneous screw fixation, in the period from 2001 to 2013 were included in this retrospective study. Minimal displacement was considered to be less than 5 mm. As well as the collection and analysis of baseline data, Harris Hip Score, Merle d'Aubigné score and Short Form 12 (SF-12) questionnaire data were recorded in the context of a clinical study. To better account for confounding factors, patients of each group were matched. The matched-pair criteria included age, BMI, Letournel fracture classification and the presence of associated injuries.
Twenty-five patients from each group were matched. On the Harris Hip Score, conservatively treated patients obtained 96 points (52-100, SD 17) vs. 89 points (45-100, SD 17, p = 0.624). On the Merle d'Aubigné score, conservatively treated patients obtained 17 points (10-18, SD 2) vs. 17 points (11-18, SD 2, p = 0.342). Patients with acetabular fractures treated by minimally invasive screw fixation did not result in improved quality of life, measured by SF-12 questionnaire, compared to conservatively treated patients (PCS 47, SD 9 vs. 44, SD 10; p = 0.294 and MCS 51, SD 7 vs. 53, SD 7; p = 0.795).
The clinical results of the two groups revealed no statistically significant differences. From the data, it cannot be deduced that minimally invasive surgical therapy is superior to conservative treatment of minimally displaced acetabular fractures. Prospective randomised studies are recommended to allow reliable evaluation of both treatment options.
Retrospectively registered.
目前治疗轻度移位髋臼骨折的方法包括保守治疗和微创经皮螺钉固定。髋臼骨折螺钉固定可改善生物力学稳定性，使患者早期完全负重。与保守治疗相比，微创螺钉固定能否长期改善髋臼骨折患者的关节活动度、疼痛和活动能力以及生活质量？
本回顾性研究纳入 2001 年至 2013 年间接受保守或闭合复位经皮螺钉固定治疗的轻度移位髋臼骨折患者。认为轻度移位是指小于 5mm。除了收集和分析基线数据外，还记录了 Harris 髋关节评分、Merle d'Aubigné 评分和健康调查简表 12 项（Short Form 12，SF-12）问卷数据。为了更好地考虑混杂因素，对每组患者进行了匹配。匹配的标准包括年龄、BMI、Letournel 骨折分型和合并损伤。
每组匹配了 25 例患者。在 Harris 髋关节评分方面，保守治疗患者得分为 96 分（52-100，SD 17），而微创螺钉固定组为 89 分（45-100，SD 17，p = 0.624）。在 Merle d'Aubigné 评分方面，保守治疗患者得分为 17 分（10-18，SD 2），而微创螺钉固定组为 17 分（11-18，SD 2，p = 0.342）。与保守治疗相比，微创螺钉固定治疗髋臼骨折患者的生活质量并未改善，SF-12 问卷测量的躯体健康评分（PCS，47，SD 9 分比 44，SD 10 分；p = 0.294）和心理健康评分（MCS，51，SD 7 分比 53，SD 7 分；p = 0.795）无统计学差异。
两组的临床结果无统计学差异。从数据来看，不能推断微创外科治疗优于保守治疗轻度移位髋臼骨折。建议进行前瞻性随机研究，以可靠地评估这两种治疗选择。
回顾性注册。
