From the Department of Orthopaedic Surgery (Perdue, Toney), Christiana Hospital, Newark, DE (Tainter) Virginia Commonwealth University, Richmond, VA, and the Department of Orthopaedic Surgery (Lee), University of California, Los Angeles, Los Angeles, CA.
J Am Acad Orthop Surg. 2021 Nov 1;29(21):e1057-e1067. doi: 10.5435/JAAOS-D-20-01301.
Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.
后壁髋臼骨折通常由高能机制引起，可与各种骨科和非骨科损伤相关。它们的范围从孤立的简单模式到多骨折，有或没有边缘嵌顿。髋关节稳定性的确定，这可能取决于骨折块的位置、大小和移位，指导着治疗方法。尽管 CT 在评估后壁骨折方面很重要，但在确定稳定性方面却不可靠。麻醉下动态荧光透视检查（EUA）是评估髋关节稳定性的基准，通过 EUA 确定为稳定的骨折具有良好的影像学和功能结果。对于符合手术标准的骨折，准确的关节复位可指导治疗结果。关节清创、明确和抬高压碎、附加固定后上和周围边缘碎片以及标准支撑钢板固定是至关重要的。骨折和手术固定的并发症包括坐骨神经损伤、创伤后骨关节炎、股骨头坏死和异位骨化。尽管关节复位的准确性对成功的结果至关重要，但其他超出外科医生控制范围的因素，如粉碎性骨折、股骨头病变和脱位，也会导致不良结果。即使关节表面得到解剖学恢复，也不能保证良好的临床结果，并且可能会出现残留的功能缺陷。
