Tigani Domenico, Lamattina Luigigiuseppe, Assenza Andrea, Melucci Giuseppe, Pizzo Alex, Donadono Cesare
Department of Orthopedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133 Bologna, Italy.
Department of Orthopedic Surgery, Ospedale Antonio Cardarelli di Campobasso, Contrada Tappino, 86100 Campobasso, Italy.
J Pers Med. 2025 Jul 1;15(7):282. doi: 10.3390/jpm15070282.
Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12-57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional "fix or replace" to a more integrated "fix and replace" approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0-3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient's needs, and advancing care for complex acetabular fractures.
切开复位内固定术（ORIF）被广泛认为是髋臼骨折的主要治疗方法，但在复杂病例中存在局限性，会导致复位不解剖，并增加创伤后骨关节炎的风险。鉴于ORIF术后继发性关节炎的发生率较高（12% - 57%），全髋关节置换术（THA）往往是必要的，特别是在不适合ORIF的情况下，如广泛粉碎性骨折或合并股骨头和颈部骨折。手术方式已从传统的“固定或置换”转变为更综合的“固定并置换”方法，这对治疗骨质疏松性骨骼的老年患者尤为有益。THA适用于不同的时间线，包括急性期（0 - 3周）、延迟期（3周 - 3个月）和晚期（超过3个月），每个阶段都有独特的挑战，需要特定的策略来优化治疗效果。强调了精确的骨缺损分类的重要性以及双动髋臼杯在降低脱位风险中的作用，同时还提到了使用现代手术和固定技术来提高稳定性和患者治疗效果。强化康复方案和细致的术后管理对于处理并发症（如感染和内固定物干扰）、根据每个患者的需求定制治疗方法以及推进复杂髋臼骨折的治疗至关重要。
