Brodell James D, Shaikh Hashim J F, Rodenhouse Thomas F, Giordano Brian D, Ketz John P, Soin Sandeep P, Joseph Noah M
Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY; and.
OrthoIndy, Indianapolis, IN.
J Orthop Trauma. 2025 May 1;39(5):229-236. doi: 10.1097/BOT.0000000000002958.
While rates of posttraumatic osteoarthritis after acetabulum fracture have been thoroughly studied, there has been less emphasis on hip osteoarthritis after pelvic ring injuries. The objective of this study was to determine the frequency of posttraumatic hip osteoarthritis in pelvic ring injury patients. It was hypothesized that more severe pelvic ring injuries would be associated with greater rates of posttraumatic hip osteoarthritis.
Retrospective Cohort.
Urban/Suburban Academic Level I Trauma Center.
Subjects were identified using a retrospective search for OTA/AO type A, B, and C pelvic ring injuries. Patients were included if they were aged 18 years or older, had a pelvic ring injury, and had 1 year or more of radiographic follow-up. Patients were excluded if they had prior total hip arthroplasty or hip hemiarthroplasty, femoral neck fracture, acetabulum fracture, femoral head fracture, or inadequate radiographic follow-up.
Both hips were graded using the Tönnis classification at the time of injury and available follow-up pelvis films. Comparison of rate of osteoarthritis progression was made between stable (LC I injuries stable on examination under anesthesia, all APC I injuries) and unstable (APC II, APC III, LC II, LC III, and LC I injuries unstable on examination under anesthesia) pelvic ring injury patients, as well as severity of injury using the Young-Burgess classification.
Two hundred eleven patients were included for final analysis. Average age was 58.8 years (SD 28.1 years, range 18-100 years). Eighty-eight patients (41.7%) were male. One hundred twenty-seven patients underwent nonoperative management, and 84 underwent surgical stabilization. 34.5% (29/84) of patients with unstable pelvic ring injuries and 6.2% (8/127) of patients with stable pelvic ring injuries demonstrated progression of osteoarthritis on the ipsilateral side of their injury ( P < 0.001). More severe pelvic ring injury patterns had a greater rate of posttraumatic osteoarthritis (PTOA) based on the Young-Burgess injury classification (44.4% of LC III vs. 11.1% of LC I pelvic ring injury patients, P < 0.001).
A significant frequency of posttraumatic osteoarthritis after pelvic ring injuries was identified. A higher rate of progression to PTOA was found with unstable injuries compared with stable pelvic injuries.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
虽然髋臼骨折后创伤性骨关节炎的发生率已得到充分研究，但骨盆环损伤后髋骨关节炎却较少受到关注。本研究的目的是确定骨盆环损伤患者创伤后髋骨关节炎的发生率。研究假设是更严重的骨盆环损伤与创伤后髋骨关节炎的更高发生率相关。
回顾性队列研究。
城市/郊区一级学术创伤中心。
通过回顾性检索OTA/AO A、B和C型骨盆环损伤来确定研究对象。纳入年龄在18岁及以上、有骨盆环损伤且有1年或更长时间影像学随访的患者。排除既往有全髋关节置换术或半髋关节置换术、股骨颈骨折、髋臼骨折、股骨头骨折或影像学随访不充分的患者。
在受伤时以及可获得的随访骨盆X线片上，使用Tönnis分类法对双侧髋关节进行分级。比较稳定型（麻醉下检查稳定的LC I损伤、所有APC I损伤）和不稳定型（APC II、APC III、LC II、LC III以及麻醉下检查不稳定的LC I损伤）骨盆环损伤患者骨关节炎进展的发生率，以及使用Young-Burgess分类法评估损伤的严重程度。
211例患者纳入最终分析。平均年龄为58.8岁（标准差28.1岁，范围18 - 100岁）。88例（41.7%）为男性。127例患者接受非手术治疗，84例接受手术固定。不稳定骨盆环损伤患者中34.5%（29/84）以及稳定骨盆环损伤患者中6.2%（8/127）在损伤同侧出现骨关节炎进展（P < 0.001）。根据Young-Burgess损伤分类，更严重的骨盆环损伤类型创伤后骨关节炎（PTOA）发生率更高（LC III损伤患者中有44.4%，而LC I骨盆环损伤患者中有11.1%，P < 0.001）。
确定了骨盆环损伤后创伤性骨关节炎的显著发生率。与稳定骨盆损伤相比，不稳定损伤进展为PTOA的发生率更高。
预后性III级。有关证据水平的完整描述，请参阅作者指南。
