Walls Andrew, McAdam Andrew, McMahon Samuel E, Diamond Owen J
Specialist Registrar Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, UK.
Core Surgical Trainee, Royal Victoria Hospital, Belfast, UK.
Surgeon. 2021 Oct;19(5):e289-e297. doi: 10.1016/j.surge.2021.01.002. Epub 2021 Feb 14.
Acetabular fractures in the elderly are challenging. Management is complicated by patients' poor physiological status and osteoporotic bone. Analysis of the management of these patients must be separated from the treatment of younger patients. Conservative management continues to have a role in patients who sustain fractures that are non-displaced and are considered stable with weight bearing mobilisation, and in those patients considered too medically frail to undergo surgical intervention. The mainstay of current surgical intervention is open reduction and internal fixation (ORIF) and variations of ORIF and total hip arthroplasty (THA), or fix and replace. Fix and replace is being increasingly favoured in those patients who display poor prognostic factors for long term joint survival after ORIF. Percutaneous fixation has the theoretical benefits of minimally invasive surgery and the potential to make any subsequent THA less complicated. However, it requires specialised fluoroscopic skills and is not suitable for all fracture patterns. There are a number of developments being reported. The use of a reinforcement ring and THA in has been reported in a number of centres, as has the use of trabecular metal acetabular implants. A coned hemi pelvic prosthesis and THA has been described in our centre, with promising early results. The potential for 3D printing to improve preoperative planning and reduce intra-operative time is also being explored. The aim of this review is to provide a summary of the literature supporting current and future treatment methods, tips on reduction techniques and an overview of the treatment algorithm of these patients in our unit.
老年髋臼骨折具有挑战性。患者生理状态差和骨质疏松性骨使治疗变得复杂。对这些患者治疗的分析必须与年轻患者的治疗区分开来。保守治疗在那些骨折无移位且负重活动被认为稳定的患者，以及那些因身体过于虚弱而无法接受手术干预的患者中仍发挥着作用。当前手术干预的主要方式是切开复位内固定（ORIF）以及ORIF的变体和全髋关节置换术（THA），即固定并置换。对于那些在ORIF后显示出长期关节存活预后不良因素的患者，固定并置换越来越受到青睐。经皮固定具有微创手术的理论优势，并且有可能使后续的THA手术并发症减少。然而，它需要专门的透视技能，且并不适用于所有骨折类型。有许多新进展被报道。一些中心报道了使用加强环和THA，以及使用小梁金属髋臼植入物。我们中心描述了一种锥形半骨盆假体和THA，早期结果令人鼓舞。3D打印改善术前规划并减少手术时间的潜力也在探索中。本综述的目的是总结支持当前和未来治疗方法的文献、复位技术要点以及我们科室对这些患者的治疗算法概述。
