Central Adelaide Local Health Network, Department of Surgery, Adelaide, Australia.
Royal Adelaide Hospital, Orthopaedic Trauma, Adelaide, Australia; The University of Adelaide, Trauma & Orthopaedics, Adelaide, Australia.
Injury. 2020 Oct;51(10):2267-2277. doi: 10.1016/j.injury.2020.06.016. Epub 2020 Jun 24.
Surgical management of acetabular fractures is now commonplace for almost all displaced or unstable fractures. Over the last 20 years however, the patient population has aged, and there have been significant changes to safety in motor vehicles and the work-place, and people's activity types and levels have changed. The surgical specialty has also developed with time, and as a result acetabular fracture surgery today is different to 20 years ago. We have repeated a meta-analysis originally published by Giannoudis et al in 2005, to evaluate contemporary aspects of acetabular fracture patients, injury mechanisms, management, complications and functional outcomes. This paper compares data from the last 15 years to that published in 2005. We have analysed a total of 8389 fractures from 8372 patients. The mean patient age has risen from 38.6 to 45.2. A change in injury mechanisms is seen, with road traffic accidents now accounting for 66.5% of cases (previously over 80%), and a rise in the number of fractures caused by falls from 10.7 to 25.8%. There has been a marked change in the fracture types seen, with a significant rise in anterior column-based fractures (Anterior column and Anterior column posterior hemi-transverse), whilst all other fracture patterns have fallen over time. Surgery is now taking place earlier, the Kocher-Langenbeck and Ilioinguinal approaches remain the major surgical approaches used, but the Anterior Intra-Pelvic approach has become relatively common. The most significant change in complications is a substantial drop in iatrogenic nerve damage, particularly to the sciatic nerve. Post-traumatic osteoarthritis remains the major complication of this injury, with 16.9% of cases developing Matta grade III/IV changes by 44 months in this review. Heterotopic ossification also remains a common problem. Despite these changes over time, functional outcomes after acetabular fracture appear to remain similar, although there is still a lack of good quality data on medium and longer-term functional outcomes from which to assess this.
现在，对于几乎所有移位或不稳定的髋臼骨折，手术治疗已经很常见。然而，在过去的 20 年中，患者人群老龄化，机动车和工作场所的安全性发生了重大变化，人们的活动类型和水平也发生了变化。外科专业也随着时间的推移而发展，因此今天的髋臼骨折手术与 20 年前不同。我们重复了 Giannoudis 等人在 2005 年发表的一项荟萃分析，以评估髋臼骨折患者、损伤机制、治疗、并发症和功能结果的当代方面。本文将最后 15 年的数据与 2005 年发表的数据进行了比较。我们共分析了 8372 例患者的 8389 处骨折。患者的平均年龄从 38.6 岁上升到 45.2 岁。损伤机制发生了变化，道路交通伤现在占 66.5%（以前超过 80%），跌倒引起的骨折数量从 10.7%上升到 25.8%。所见到的骨折类型发生了明显变化，前柱型骨折（前柱和前柱后半横形）显著增加，而所有其他骨折类型随时间推移而减少。手术现在进行得更早，Kocher-Langenbeck 和髂腹股沟入路仍然是主要的手术入路，但前盆腔入路变得相对常见。并发症方面的最大变化是医源性神经损伤显著减少，特别是坐骨神经损伤。创伤后骨关节炎仍然是这种损伤的主要并发症，在本综述中，44 个月时，6.9%的病例出现 Matta 分级 III/IV 改变。异位骨化仍然是一个常见的问题。尽管随着时间的推移发生了这些变化，但髋臼骨折后的功能结果似乎仍然相似，尽管仍然缺乏关于中期和长期功能结果的高质量数据来对此进行评估。
