Orthopaedic Subspecialty Research Centre (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
BMC Musculoskelet Disord. 2024 Nov 29;25(1):976. doi: 10.1186/s12891-024-08114-5.
Acetabular fractures can lead to persistent pain and disability. Managing these complex injuries involves several treatment options such as nonoperative methods, percutaneous fixation, open reduction internal fixation (ORIF), and total hip arthroplasty (THA), and various combinations of these techniques. Around 20 to 40% of patients treated with ORIF may develop post-traumatic arthritis requiring THA. To pinpoint the factors contributing to initial treatment failure of acetabular fractures and the subsequent need for THA conversion, we are conducting a systematic review of relevant literature.
A thorough search of PubMed, Scopus, Web of Science, and Embase databases yielded studies investigating risk factors linked to the conversion of acetabular fracture treatment to THA. Inclusion criteria were employed, and data extraction, as well as quality assessment, were conducted by two reviewers. Utilizing R software, meta-analyses were conducted employing the Mantel-Haenszel method. Random-effect models were employed when the I was greater than 50% (Heterogeneous data). A P-value less than 0.05 is considered statistically significant.
In this systematic review involving 25 pertinent studies, our analysis unveiled significant risk factors contributing to the conversion from initial acetabular fracture treatment to THA. Notable factors included advanced age (SMD [95%CI] = 0.43 [0.17-0.69]), female gender (OR [95%CI] = 1.65 [1.15-2.38]), posterior wall involvement (OR [95%CI] = 1.81 [1.32-2.47]), acetabular impaction (OR [95%CI] = 3.23 [1.99-5.25]), femoral impaction (OR [95%CI] = 6.08 [3.35-11.05]), and femoral head dislocation (OR [95%CI] = 3.94 [2.02-7.70]). Associated fracture type exhibited no significant link to the risk of conversion to THA.
Recognizing these factors allows for the adjustment of patient expectations, providing them with information about the potential necessity of THA in the future. Patients exhibiting these risk factors may derive greater benefits from treatment administered by experienced surgeons.
髋臼骨折可导致持续疼痛和残疾。治疗这些复杂损伤需要多种治疗方法，如非手术方法、经皮固定、切开复位内固定（ORIF）和全髋关节置换术（THA），以及这些技术的各种组合。接受 ORIF 治疗的患者中，约有 20%至 40%可能会发展为创伤后关节炎，需要进行 THA。为了确定导致髋臼骨折初始治疗失败和随后需要进行 THA 转换的因素，我们正在对相关文献进行系统综述。
通过对 PubMed、Scopus、Web of Science 和 Embase 数据库的全面检索，获得了研究髋臼骨折治疗转换为 THA 的相关风险因素的研究。采用纳入标准，由两名评审员进行数据提取和质量评估。使用 R 软件，采用 Mantel-Haenszel 方法进行荟萃分析。当 I 大于 50%（异质性数据）时，采用随机效应模型。P 值小于 0.05 被认为具有统计学意义。
在这项涉及 25 项相关研究的系统综述中，我们的分析揭示了导致初始髋臼骨折治疗向 THA 转换的显著风险因素。显著的因素包括年龄较大（SMD[95%CI] = 0.43[0.17-0.69]）、女性（OR[95%CI] = 1.65[1.15-2.38]）、后壁受累（OR[95%CI] = 1.81[1.32-2.47]）、髋臼撞击（OR[95%CI] = 3.23[1.99-5.25]）、股骨干撞击（OR[95%CI] = 6.08[3.35-11.05]）和股骨头脱位（OR[95%CI] = 3.94[2.02-7.70]）。相关骨折类型与向 THA 转换的风险无显著关联。
认识到这些因素可以调整患者的期望，为他们提供有关未来可能需要进行 THA 的信息。表现出这些风险因素的患者可能会从经验丰富的外科医生的治疗中获得更大的益处。
