Sen Ramesh Kumar, Tripathy Sujit Kumar
Institute of Orthopaedics, Max Hospital, Mohali, Punjab India.
Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India.
Indian J Orthop. 2025 Jan 4;59(3):300-310. doi: 10.1007/s43465-024-01329-7. eCollection 2025 Mar.
The surgical management of osteoporotic pelviacetabular fractures poses distinct challenges due to poor screw purchase, severe comminution of fractures, and the inability to perform prolonged surgeries in patients with significant comorbidities. These fractures necessitate tailored modifications in surgical approaches, implant selection, and techniques based on the patient's overall health, fracture complexity, and bone quality.
A comprehensive literature search was conducted using PubMed and Google Scholar databases to identify relevant articles on the management of osteoporotic pelvi-acetabular fractures.
Implant selection plays a pivotal role in addressing the fragility of osteoporotic fractures. Specialized implants, such as locking plates with multidirectional screw holes, along with augmentation using polymethylmethacrylate (PMMA) or bone substitutes, enhance screw fixation in compromised bone. Sacral fractures, which are commonly involved, are often managed with percutaneous fixation using long cancellous screws. Minimally invasive long-screw fixation techniques are particularly effective for less displaced acetabular fractures. For displaced acetabular fractures with articular impaction, fracture elevation and stabilization using bone grafts or bone graft substitutes are crucial. When feasible, less invasive surgical techniques are preferred to minimize operative trauma. In some cases, the fixation of acetabular fractures in osteoporotic bone may fail over time, necessitating conversion to total hip arthroplasty (THA). For fractures with severe comminution, primary THA combined with column reduction and fixation is frequently a safer and more effective approach. Early postoperative mobilization is critical to reduce the risk of complications such as deep vein thrombosis and pressure ulcers.
The stabilization of osteoporotic pelvic and acetabular fractures requires a multifaceted approach incorporating advanced surgical techniques, specialized implants, and augmentation methods. Early mobilization and individualized postoperative management are essential for optimizing patient outcomes and minimizing complications.
由于螺钉把持力差、骨折严重粉碎以及合并严重基础疾病的患者无法耐受长时间手术，骨质疏松性骨盆髋臼骨折的外科治疗面临独特挑战。这些骨折需要根据患者的整体健康状况、骨折复杂性和骨质质量，对手术入路、植入物选择和技术进行针对性调整。
使用PubMed和谷歌学术数据库进行全面的文献检索，以确定有关骨质疏松性骨盆髋臼骨折治疗的相关文章。
植入物的选择在应对骨质疏松性骨折的脆弱性方面起着关键作用。专门的植入物，如带有多方向螺孔的锁定钢板，以及使用聚甲基丙烯酸甲酯（PMMA）或骨替代物进行强化，可增强在骨质不佳的情况下的螺钉固定。常见的骶骨骨折通常采用长松质骨螺钉经皮固定。微创长螺钉固定技术对移位较小的髋臼骨折特别有效。对于伴有关节嵌插的移位髋臼骨折，使用骨移植或骨移植替代物进行骨折复位和固定至关重要。在可行的情况下，首选侵入性较小的手术技术以尽量减少手术创伤。在某些情况下，骨质疏松性骨中髋臼骨折的固定可能会随着时间推移而失败，需要转换为全髋关节置换术（THA）。对于严重粉碎的骨折，一期THA联合柱形复位和固定通常是一种更安全、更有效的方法。术后早期活动对于降低深静脉血栓形成和压疮等并发症的风险至关重要。
骨质疏松性骨盆和髋臼骨折的稳定需要采用多方面的方法，包括先进的手术技术、专门的植入物和强化方法。早期活动和个体化的术后管理对于优化患者预后和减少并发症至关重要。
