Gänsslen Axel, Freude Thomas, Lindahl Jan, Krappinger Dietmar
Trauma Department, Hannover Medical School, Hannover, Germany.
Department of Trauma and Orthopedics, Johannes Wesling Hospital, Minden, Germany.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):20. doi: 10.1007/s00402-024-05611-z.
Impactions of the articular surface are relevant prognostic parameters in the treatment of acetabular fractures. Posterior marginal impactions and acetabular dome impactions may occur depending on the direction of the force vectors during trauma. Posterior marginal impactions are mainly observed in posterior fracture dislocations, while acetabular dome impactions are frequently seen in the elderly with the hip joint in extension during trauma. Femoral head impactions are also frequently associated with acetabular fractures, mainly in fracture dislocations and transverse acetabular fractures. CT scans using thin slices are mandatory in order to preoperatively identify acetabular and femoral head impactions. Intraoperatively, the reduction techniques depend on the type of marginal impaction. Posterior impactions are usually addressed via a posterior approach by applying femoral traction under direct visualization or even by performing surgical hip dislocation. Acetabular dome impactions may be reduced using the fracture lines or by creating a cortical window. Reduction is followed by filling the void with bone or bone substitutes supported by raft screws. No clear treatment recommendations for femoral head impactions are given in the literature.
关节面撞击是髋臼骨折治疗中的相关预后参数。根据创伤时力向量的方向，可能会出现后缘撞击和髋臼顶撞击。后缘撞击主要见于后脱位骨折，而髋臼顶撞击常见于创伤时髋关节处于伸展位的老年人。股骨头撞击也常与髋臼骨折相关，主要见于骨折脱位和髋臼横行骨折。为了术前识别髋臼和股骨头撞击，必须使用薄层CT扫描。术中，复位技术取决于边缘撞击的类型。后缘撞击通常通过后路，在直视下施加股骨牵引，甚至通过手术性髋关节脱位来处理。髋臼顶撞击可利用骨折线或通过创建皮质骨窗进行复位。复位后，用骨或骨替代物填充空隙，并由 raft 螺钉支撑。文献中未给出关于股骨头撞击的明确治疗建议。
