MacCormick Lauren M, Lin Carol A, Westberg Jerald R, Schmidt Andrew H, Templeman David C
University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, Minnesota.
Orthopedic Center, Cedars-Sinai Medical Center, Los Angeles, California.
OTA Int. 2019 Mar 12;2(1):e014. doi: 10.1097/OI9.0000000000000014. eCollection 2019 Mar.
Open reduction internal fixation (ORIF) is the standard of care for displaced acetabular fractures, but the inability to achieve anatomic reduction, involvement of the posterior wall, articular impaction, and femoral head cartilaginous injury are known to lead to poorer outcomes. Acute total hip arthroplasty (THA) is a reasonable treatment option for older patients with an acetabular fracture and risk factors for a poor outcome, but it is only described in case series. The purpose of this study is to compare outcomes of ORIF and acute THA in middle-aged patients with an acetabular fracture from a single center.
Retrospective case-controlled study of patients aged 45 to 65 years old with acetabular fractures involving the posterior wall treated with acute THA or ORIF at a level 1 trauma center between 1996 and 2011. Patients were matched by fracture pattern and age at a 2 (ORIF):1 (acute THA) ratio. Functional outcome, complications, and reoperation rates of acute THA and ORIF were compared.
Sixteen acute THA patients (average age 56.4 years) and 32 ORIF patients (average age 54.3 years) were evaluated at an average follow-up of 6.2 years (range 1-15.2). The average Oxford Hip Score in the acute THA group was 44 compared to 40 in the ORIF group (P = .075). Complication rates were similar between both the groups. Twelve hips (37%) in the ORIF group had undergone THA or been referred for THA, and 2 revisions (13%) had occurred in the acute THA group. A Kaplan-Meier survival analysis showed that those undergoing acute THA had significantly better survival of their index procedure (.031).
Both ORIF and acute THA for high-energy acetabular fractures involving the posterior wall in middle-aged patients can provide excellent results, with acute THA patients achieving improved survival of the index procedure and improved functional scores.
切开复位内固定术（ORIF）是移位髋臼骨折的标准治疗方法，但已知无法实现解剖复位、后壁受累、关节撞击以及股骨头软骨损伤会导致预后较差。对于髋臼骨折且有预后不良风险因素的老年患者，急性全髋关节置换术（THA）是一种合理的治疗选择，但仅在病例系列中有描述。本研究的目的是比较单中心中年髋臼骨折患者行ORIF和急性THA的疗效。
对1996年至2011年在一级创伤中心接受急性THA或ORIF治疗的45至65岁后壁累及型髋臼骨折患者进行回顾性病例对照研究。患者按骨折类型和年龄以2（ORIF）:1（急性THA）的比例进行匹配。比较急性THA和ORIF的功能结局、并发症及再次手术率。
共评估了16例急性THA患者（平均年龄56.4岁）和32例ORIF患者（平均年龄54.3岁），平均随访6.2年（范围1 - 15.2年）。急性THA组的平均牛津髋关节评分是44分，而ORIF组为40分（P = 0.075）。两组的并发症发生率相似。ORIF组有12髋（37%）接受了THA或被转诊行THA，急性THA组发生了2例翻修（13%）。Kaplan - Meier生存分析显示，接受急性THA的患者其初次手术的生存率显著更高（P = 0.031）。
对于中年患者中累及后壁的高能髋臼骨折，ORIF和急性THA均可取得良好效果，急性THA患者的初次手术生存率更高，功能评分也有所改善。
