Regenbogen Stephan, Grützner Paul A, Beck Markus, Blum Philipp, Stöckle Ulrich, Osten Philipp, Märdian Sven, Jaecker Vera
Department for Orthopaedics and Trauma Surgery at Heidelberg University, BG Klinik Ludwigshafen, Ludwigshafen, Germany.
Department of Traumatology and General Surgery, BG Unfallklinik Murnau, Murnau, Germany.
Arch Orthop Trauma Surg. 2025 Aug 28;145(1):430. doi: 10.1007/s00402-025-06048-8.
Traumatic hip dislocations are rare but serious injuries, potentially affecting patients' quality of life and mobility. Given the limited understanding of prognostic factors, this study aimed to identify predictors of long-term clinical outcomes.
Injury characteristics and computed tomography (CT) of patients following traumatic hip dislocation from two level I trauma centers from 2009 to 2015 were analyzed. At follow-up, patients were evaluated for avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), secondary surgery, complications, and return to sports. Patient-reported outcome measures (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS), were evaluated.
38 patients with traumatic hip dislocation were finally included. Concomitant posterior acetabular wall fractures and femoral head fractures (Pipkin type I to IV) were observed in 34 cases (87%). 18 patients (mean age 38.3 ± 17.2 years) completed the follow-up (mean follow-up 12.25 ± 1.03 years). 6 patients (33%) developed PTOA, 2 patients (11%) AVN, and 3 patients (17%) required total hip arthroplasty. Decreased TAS was associated with concomitant fractures (p = 0.02). 10 patients (56%) did not return to their pre-injury sports level and 7 patients (39%) reported sexual dysfunction. PROMs and return to sports were significantly worse in patients with PTOA or residual sciatic nerve injury (p < 0.05).
Patients after traumatic hip dislocation are at high risk for PTOA or AVN, especially with concomitant acetabular or femoral head fractures, resulting in significant long-term limitations in daily activities, sports, and sexual function. Recognition of concomitant fractures is a critical prognostic factor in assessing long-term outcomes.
创伤性髋关节脱位虽罕见但伤势严重，可能影响患者的生活质量和行动能力。鉴于对预后因素的了解有限，本研究旨在确定长期临床结果的预测因素。
分析了2009年至2015年来自两个一级创伤中心的创伤性髋关节脱位患者的损伤特征和计算机断层扫描（CT）结果。随访时，对患者进行了无血管坏死（AVN）、创伤后骨关节炎（PTOA）、二次手术、并发症及恢复运动情况的评估。评估了患者报告的结局指标（PROMs），包括特格纳活动量表（TAS）和改良哈里斯髋关节评分（mHHS）。
最终纳入38例创伤性髋关节脱位患者。34例（87%）观察到合并髋臼后壁骨折和股骨头骨折（Pipkin I型至IV型）。18例患者（平均年龄38.3±17.2岁）完成随访（平均随访12.25±1.03年）。6例患者（33%）发生PTOA，2例患者（11%）发生AVN，3例患者（17%）需要全髋关节置换术。TAS降低与合并骨折有关（p = 0.02）。10例患者（56%）未恢复到受伤前的运动水平，7例患者（39%）报告有性功能障碍。PTOA或坐骨神经损伤残留的患者，其PROMs和恢复运动情况明显更差（p < 0.05）。
创伤性髋关节脱位后的患者发生PTOA或AVN的风险很高，尤其是合并髋臼或股骨头骨折时，会导致日常活动、运动和性功能出现显著的长期限制。认识合并骨折是评估长期结局的关键预后因素。
