Umraniye Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Istanbul Medeniyet University, Faculty of Medicine, Göztepe Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Orthop Surg. 2022 Apr;14(4):652-662. doi: 10.1111/os.13245. Epub 2022 Mar 16.
OBJECTIVE: To perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and functional outcomes reported in literature written in English. METHODS: This review was performed by searching PubMed, Cochrane Library, Scopus, and Web of Science without a filter for time limitation in line with Preferred Reporting Items for Systematic Reviews Protocols (PRISMA-P) guidelines. Two authors took part in screening and evaluating the literature between December 2020 and January 2021. The terms acetabulum fracture, reduction, fixation, femur head fracture, fracture dislocation of the hip, hip trauma and arthroscopy or arthroscopic, and their combinations were used to search four database engines in the titles and abstracts of the reported papers. Only papers with English titles and abstracts were included. The assessment of the data related to descriptions of the techniques, indications for fracture fixation using arthroscopy, and patient-related outcomes. RESULTS: Perfect agreement was detected between the two reviewers during all steps of the review process (κ = 0.81-1.00). Although a meta-analysis was planned to be carried out, no randomized controlled study comparing either the radiological or functional results of different surgical techniques was detected in the literature. Nineteen studies were included in the study. Of these, 15 were retrospective case reports and four were case series. Twenty-seven patients were operated on for acetabulum fractures (18 male/nine female). The mean age was 28.3 years (range, 15-53 years). High-energy traumas including motor vehicle accidents were the most common reason (81%). The duration of follow-up was a mean of 32 months (range, 12-68 months). Sixteen patients were operated on for femur fractures (12 male/three female). The mean age was 30.1 years (range, 17-50 years). Motor vehicle accident was the most common trauma (70%). Duration of follow-up had a mean of 18 months (range, 4-60 months). Patient-related outcomes were excellent for reported cases in both groups despite the fact that an objective scoring system was not used for most of the cases. Moreover, there was no consensus on surgical indications or the techniques. CONCLUSIONS: The techniques of arthroscopic-assisted fixation of acetabulum and femoral head fracture are so heterogeneous that conclusions cannot be made at this time, but there is potential for this method of treatment to become more popular as the devices used in the procedure develop and as exposure to and experience with hip arthroscopy improves. Further descriptions of reduction and fixation techniques and analysis of outcomes of RCTs are needed.
目的:系统评价确定目前髋关节骨折的关节镜固定技术,并评估英文文献中报道的影像学和功能结果。
方法:本综述通过搜索 PubMed、Cochrane 图书馆、Scopus 和 Web of Science,按照系统评价报告的首选条目(PRISMA-P)指南进行了无时间限制的筛选。两名作者于 2020 年 12 月至 2021 年 1 月期间参与了筛选和评估文献。使用髋臼骨折、复位、固定、股骨头骨折、髋关节骨折脱位、髋关节创伤和关节镜或关节镜下及其组合等术语,在报告文献的标题和摘要中搜索了四个数据库引擎。仅纳入有英文标题和摘要的文献。评估了与技术描述、关节镜下骨折固定适应证以及与患者相关的结果相关的数据。
结果:在整个审查过程中,两位审查员之间的一致性非常高(κ=0.81-1.00)。尽管计划进行荟萃分析,但在文献中未发现比较不同手术技术的影像学或功能结果的随机对照研究。研究共纳入 19 项研究。其中,15 项为回顾性病例报告,4 项为病例系列研究。27 例患者接受髋臼骨折手术(18 例男性/9 例女性)。平均年龄为 28.3 岁(范围 15-53 岁)。高能量创伤包括机动车事故是最常见的原因(81%)。随访时间平均为 32 个月(范围 12-68 个月)。16 例患者接受股骨头骨折手术(12 例男性/3 例女性)。平均年龄为 30.1 岁(范围 17-50 岁)。机动车事故是最常见的创伤(70%)。随访时间平均为 18 个月(范围 4-60 个月)。尽管大多数病例未使用客观评分系统,但报告病例的患者相关结果均为优秀。此外,手术适应证或技术尚无共识。
结论:关节镜辅助固定髋臼和股骨头骨折的技术非常多样化,目前无法得出结论,但随着该手术中使用的设备的发展以及髋关节镜技术的普及和经验的积累,这种治疗方法可能会变得更加流行。需要进一步描述复位和固定技术,并分析随机对照试验的结果。
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