Acute treatment of elderly patients with acetabular fractures by open reduction, internal fixation, and total hip arthroplasty: a 1-10-year follow-up of 48 patients.

IF 2.5 2区 医学 Q1 ORTHOPEDICS
Ragnhild Loven Kirkeboe, Jan Erik Madsen, Lars Nordsletten, John Clarke-Jenssen
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引用次数: 0

Abstract

Background and purpose:  Acetabular fractures in osteoporotic bone are associated with substantial joint impaction and comminution, previously shown to be prognostic for a poor result. A combined procedure of open reduction, internal fixation (ORIF), and total hip arthroplasty (THA) can be a good option, allowing for immediate weightbearing as tolerated. We report short- to medium-term outcome and complications of the results of patients treated with this combined procedure.

Methods:  48 cases treated with ORIF and acute THA from 2000 to 2019 were identified from our local pelvic fracture registry, from which follow-up data was extracted. Descriptive statistics were used and Kaplan-Meier survival curves were calculated. Primary outcome was HHS at 1 year. Secondary outcomes were implant survival, complications requiring surgery, and mortality at 3 months.

Results:  There were 37 men and 11 women treated in the study period. Mean age was 68 (37-87) years. 6 patients died within 3 months of surgery, leaving 42 cases available for follow-up. Mean follow-up (FU) was 2.8 (1-16) years. The most common mechanism of injury was fall from standing height (n = 36). Medical comorbidities were common. Mean Harris Hip Score (HHS) was 83 (51-100) at 1-year follow-up. There were 7 reoperations: 6 for postoperative infection and 1 closed reduction of implant dislocation. 38 had their implant intact at latest FU. At the latest FU, 28 patients were ambulatory without a walking aid.

Conclusion:  Our results indicate that ORIF and acute THA can be performed with good functional results in patients with unreconstructable displaced acetabular fractures, but with a significant risk of infection and revision.

通过切开复位、内固定和全髋关节置换术对老年髋臼骨折患者进行急性治疗:对 48 名患者进行为期 1-10 年的随访。
背景和目的:骨质疏松性骨折中的髋臼骨折与严重的关节嵌顿和粉碎有关,以前的研究表明这预示着骨折效果不佳。开放复位、内固定(ORIF)和全髋关节置换术(THA)的联合手术是一个不错的选择,可以在可耐受的情况下立即负重。我们报告了采用这种联合术式治疗患者的中短期疗效和并发症。方法:我们从当地骨盆骨折登记处找到了 2000 年至 2019 年期间采用开放复位内固定术和急性 THA 治疗的 48 例患者,并从中提取了随访数据。采用描述性统计方法并计算 Kaplan-Meier 生存曲线。主要结果是 1 年后的 HHS。次要结果是植入物存活率、需要手术的并发症和3个月时的死亡率: 研究期间共有 37 名男性和 11 名女性接受了治疗。平均年龄为 68(37-87)岁。6名患者在手术后3个月内死亡,剩下42例患者接受随访。平均随访时间(FU)为 2.8(1-16)年。最常见的受伤机制是从站立高度跌落(36 例)。合并症很常见。随访1年时的平均哈里斯髋关节评分(HHS)为83(51-100)。共有 7 例再次手术:6例因术后感染,1例因假体脱位行闭合复位术。38名患者在最近一次随访时植入的假体完好无损。在最近一次随访中,28名患者无需助行器即可行走: 我们的研究结果表明,对于无法重建的移位髋臼骨折患者,ORIF和急性THA手术可以取得良好的功能效果,但感染和翻修的风险很大。
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来源期刊
Acta Orthopaedica
Acta Orthopaedica 医学-整形外科
CiteScore
6.40
自引率
8.10%
发文量
105
审稿时长
4-8 weeks
期刊介绍: Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.
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