Department of Orthopedics and Traumatology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Department of Orthopedics and Traumatology, Eskişehir State Hospital, Eskişehir, Turkey.
Acta Orthop Traumatol Turc. 2023 Jul;57(4):141-147. doi: 10.5152/j.aott.2023.22124.
The aims of this study were (i) to assess the radiological and functional outcomes of surgically treated displaced acetabular fractures and (ii) to analyze the predictive factors of poor outcomes following surgery.
A total of 119 patients (24 female, 95 male) who were operated between 2009 and 2019 were included in the study. The mean age was 47.5 years (range=18-61). The mean follow-up was 92.3 months (range=24-120). Failure to preserve the biological hip joint, as treated with total hip replacement or the Girdlestone procedure, was defined as a poor outcome. Patients' demographic information, comorbidities, fracture types, surgical approach, concomitant injuries, reduction quality, and complications were analyzed. Computed tomography was utilized to evaluate the fracture type and quality of reduction. Factors affecting poor outcomes were analyzed by logistic regression analysis. The modified Harris Hip Score was also used to evaluate the functional status.
The poor outcome rate was 10.1%. Multivariate logistic regression analysis revealed that dislocation (odds ratio: 44.87, confi- dence interval: 3.18-633.22, P=.005), wound site problems (odds ratio: 9.09, confidence interval: 1.01-81.12, P=.04), reduction quality (odds ratio: 77.88, confidence interval: 5.95-1019.07, P = .001), and diabetes (odds ratio: 7.29, confidence interval: 1.01-52.07, P = .04) were associated with poor outcomes. Eight of the 12 patients with poor outcomes had a fair Harris Hip Score, and 4 had a poor Harris Hip Score. The relationship between poor outcomes and Harris Hip Score was found to be significant (P < .001).
For a favorable functional outcome in acetabular fractures, preservation of the biological hip joint should be a top priority. The accompanying dislocation and the patient's diabetes appear to be uncontrollable factors for the poor prognosis. Good reduction qual- ity and wound infection protection are modifiable factors.
Level IV, Therapeutic Study.
本研究的目的是：(i)评估手术治疗移位髋臼骨折的影像学和功能结果；(ii)分析手术治疗后预后不良的预测因素。
共纳入 2009 年至 2019 年间手术治疗的 119 例患者（24 例女性，95 例男性）。平均年龄为 47.5 岁（范围 18-61 岁）。平均随访时间为 92.3 个月（范围 24-120 个月）。生物髋关节未能保留，即采用全髋关节置换或 Girdlestone 手术治疗，则定义为预后不良。分析患者的人口统计学资料、合并症、骨折类型、手术入路、合并损伤、复位质量和并发症。采用 CT 评估骨折类型和复位质量。采用 logistic 回归分析影响不良预后的因素。还采用改良 Harris 髋关节评分评估功能状态。
预后不良率为 10.1%。多因素 logistic 回归分析显示，脱位（优势比：44.87，置信区间：3.18-633.22，P=.005）、伤口部位问题（优势比：9.09，置信区间：1.01-81.12，P=.04）、复位质量（优势比：77.88，置信区间：5.95-1019.07，P =.001）和糖尿病（优势比：7.29，置信区间：1.01-52.07，P =.04）与预后不良相关。12 例预后不良患者中，8 例 Harris 髋关节评分为良好，4 例 Harris 髋关节评分为差。预后不良与 Harris 髋关节评分之间存在显著相关性（P<.001）。
为了获得髋臼骨折的良好功能结果，应优先保护生物髋关节。伴随的脱位和患者的糖尿病似乎是预后不良的不可控因素。良好的复位质量和伤口感染保护是可改变的因素。
IV 级，治疗研究。
