Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion C, 4th Floor, Redwood City, Stanford, CA, 94063-6342, USA.
Eur J Orthop Surg Traumatol. 2021 May;31(4):635-641. doi: 10.1007/s00590-020-02810-3. Epub 2020 Oct 24.
This study examined the complications and outcomes of geriatric acetabular fractures treated with open reduction internal fixation (ORIF) and total hip arthroplasty (THA) performed via combined ilioinguinal or anterior intrapelvic (AIP) approach to acetabulum and anterior approach to the hip.
Eight patients with a fracture of the acetabulum were treated at a Level I trauma center between 2010 and 2019 with combined ORIF/THA using an ilioinguinal or AIP approach for the acetabulum and a separate anterior approach to the hip. Wound dehiscence, peri-incisional skin necrosis, surgical site infection, dislocation, fracture union, acetabular component stability, and heterotopic ossification (HO) were utilized as outcome measures. Merle d'Aubigné-Postel scores were collected for the six patients that had one-year minimum follow-up.
The mean patient age was 77 years. Four patients had anterior wall fractures, two had associated both column fractures, and two had anterior column-posterior hemitransverse fractures. All fractures healed with stable fixation of the acetabular component by 6 months. There were no instances of skin necrosis, dislocation, infection, or re-operation. One patient had a superficial wound dehiscence that resolved with local wound care. One patient developed radiographic HO but was clinically asymptomatic. The mean Merle d'Aubigné-Postel score was 15.8 (range = 14-16).
Our small series of geriatric patients with fracture of the acetabulum treated with combined ORIF/THA, via the ilioinguinal or AIP approach with a separate anterior approach to the hip, demonstrates satisfactory outcomes with low complications after one-year of follow-up. Further research of these challenging injuries with more patients is warranted in order to determine the subset of fracture types best treated with this method and THA survivorship.
本研究通过联合髂腹股沟或骨盆前（AIP）入路髋臼和髋关节前入路，对行切开复位内固定（ORIF）和全髋关节置换术（THA）治疗的老年髋臼骨折的并发症和结果进行了评估。
2010 年至 2019 年，在一家一级创伤中心，对 8 例髋臼骨折患者采用联合 ORIF/THA 治疗，其中髋臼采用髂腹股沟或 AIP 入路，髋关节采用单独的前入路。使用切口愈合不良、切口周围皮肤坏死、手术部位感染、脱位、骨折愈合、髋臼部件稳定性和异位骨化（HO）作为结果测量指标。对 6 例具有至少 1 年随访的患者进行 Merle d'Aubigné-Postel 评分。
患者平均年龄为 77 岁。4 例患者为前壁骨折，2 例患者为合并双柱骨折，2 例患者为前柱-后半月形骨折。所有骨折均在 6 个月时通过髋臼部件稳定固定而愈合。无皮肤坏死、脱位、感染或再次手术的情况。1 例患者出现浅表伤口裂开，经局部伤口护理愈合。1 例患者出现放射学 HO，但无临床症状。平均 Merle d'Aubigné-Postel 评分为 15.8（范围=14-16）。
我们对 8 例老年髋臼骨折患者采用联合 ORIF/THA 治疗，通过髂腹股沟或 AIP 入路联合髋关节前入路，随访 1 年后并发症发生率低，结果满意。需要对这些具有挑战性的损伤进行更多患者的进一步研究，以确定最适合该方法和 THA 生存率的骨折类型亚组。
