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[人工髋关节周围髋臼骨折:分类、治疗及挑战]

[Periprosthetic acetabular fractures: classifications, treatment and challenges].

作者信息

Bartosik Mikolaj, Mayr Eckart, Culemann Ulf

机构信息

Klinik für Unfallchirurgie, Allgemeines Krankenhaus Celle, Celle, Deutschland.

Klinik für Orthopädie, Allgemeines Krankenhaus Celle, Celle, Deutschland.

出版信息

Orthopadie (Heidelb). 2024 Oct;53(10):773-781. doi: 10.1007/s00132-024-04549-9. Epub 2024 Aug 23.

Abstract

Periprosthetic acetabular fractures (PPAF) are fractures of the acetabulum with a hip endoprosthesis in place. They are a rare complication, although they are occurring more frequently due to the increase in patients being fitted with total hip arthroplasty (THA) and the long service life of the implants. At present, only a small amount of scientific literature exists, particularly regarding the surgical treatment of these fracture types.The aim of this paper is to provide an overview of the topic of PPAF with a critical review of the current literature and to present the necessary surgical treatment.An evaluation of the current literature on the topic of PPAF with a focus on the surgical treatment of fractures is carried out.Surgical treatment is technically demanding due to the pelvic ring instability with removal of the bone tension for secure acetabular cup fixation and should lead to the recovery of the biomechanical stability of the pelvis and thus the secure anchoring of the acetabular cup. An interdisciplinary approach requiring both trauma surgery and orthopaedic expertise is certainly recommended, as older and comorbid patients with poor bone quality are particularly frequently affected.The treatment of periprosthetic acetabular fractures, especially in older patients, requires not only the individual expertise of surgeon involved in the operation but also a goal-oriented and consistent interdisciplinary approach by the surgeons involved from the fields of orthopaedics and trauma surgery in view of the patients' frequent comorbidities. By working together, the optimal and individualized operation can be performed for the patient.

摘要

髋臼假体周围骨折(PPAF)是指髋臼骨折且髋部已植入假体。它们是一种罕见的并发症,不过由于接受全髋关节置换术(THA)的患者增多以及植入物使用寿命延长,其发生率正逐渐上升。目前,相关的科学文献较少,尤其是关于这些骨折类型的手术治疗方面。本文旨在对PPAF这一主题进行概述,对当前文献进行批判性综述,并介绍必要的手术治疗方法。对当前关于PPAF主题的文献进行评估,重点关注骨折的手术治疗。由于骨盆环不稳定,为确保髋臼杯固定需消除骨张力,手术治疗在技术上要求很高,且应能恢复骨盆的生物力学稳定性,从而确保髋臼杯的牢固固定。对于骨质较差的老年患者及合并症患者尤其常见,因此肯定推荐采用创伤外科和骨科专家共同参与的多学科方法。髋臼假体周围骨折的治疗,尤其是老年患者,鉴于患者常伴有合并症,不仅需要参与手术的外科医生具备个人专业知识,还需要骨科和创伤外科领域的外科医生采取目标明确且一致的多学科方法。通过共同协作,可为患者实施最佳的个体化手术。

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