Riemenschneider Julia, Vollrath Jan Tilmann, Mühlenfeld Nils, Frank Johannes, Marzi Ingo, Janko Maren
Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University, Frankfurt, Germany.
EFORT Open Rev. 2022 May 31;7(6):433-445. doi: 10.1530/EOR-22-0019.
Different treatment options for acetabular fractures in the elderly and nonagenarians exist; a consistent guideline has not been established, yet. The purpose of this study is to give an overview of how those fractures can be handled and compares two different surgical treatment methods. A total of 89 patients ≥ 18 years between 2016 and 2021 with acetabular fractures in our department received a surgical intervention with plate fixation via the Stoppa approach or a total hip arthroplasty with a Burch-Schneider ring and integrated cup. 60 patients ≥ 65 were compared in two groups, 29 patients between 65 and 79 and 31 patients ≥ 80. For comparison, data on operation times, hospitalization, complications during operation and hospital stay, blood loss and postoperative mobilization were collected. Characteristics could be found for indications for operative osteosynthesis or endoprosthetics based on the X-ray analysis. There was a tendency to treat simple fractures with osteosynthesis. Patients between 65 and 79 with an osteosynthesis had benefits in almost every comparison. Patients ≥ 80 with a plate fixation had advantages in the categories of postoperative complications, blood loss and transfusion of erythrocyte concentrates. Statistical significant differences were noticed in both groups regarding the operation time. Patients between 65 and 79 with osteosynthesis had significant benefits for postoperative complications, hospitalization, number of blood transfusions and postoperative mobilization. Finding the best supportive treatment option is difficult, and decision-making must respect fracture patterns and individual risk factors. This study shows that plate fixation via the Stoppa approach has some benefits.
对于老年人和九十多岁老人的髋臼骨折，存在不同的治疗选择；然而，尚未建立统一的指导方针。本研究的目的是概述如何处理这些骨折，并比较两种不同的手术治疗方法。2016年至2021年间，我们科室共有89例年龄≥18岁的髋臼骨折患者接受了手术干预，其中采用Stoppa入路钢板固定或使用Burch-Schneider环和一体化髋臼杯进行全髋关节置换术。将60例年龄≥65岁的患者分为两组进行比较，其中29例年龄在65至79岁之间，31例年龄≥80岁。为了进行比较，收集了手术时间、住院时间、手术中和住院期间的并发症、失血量和术后活动的数据。基于X线分析，可以发现手术骨合成或假体植入的适应症特征。对于简单骨折倾向于采用骨合成治疗。在几乎所有比较中，年龄在65至79岁且采用骨合成治疗的患者都有优势。年龄≥80岁且采用钢板固定的患者在术后并发症、失血量和红细胞浓缩物输注方面具有优势。两组在手术时间方面均存在统计学显著差异。年龄在65至79岁且采用骨合成治疗的患者在术后并发症、住院时间、输血次数和术后活动方面具有显著优势。找到最佳的支持性治疗方案很困难，决策必须考虑骨折类型和个体风险因素。本研究表明，通过Stoppa入路进行钢板固定有一些优势。
