全髋关节置换术在老年髋臼骨折中的应用

Total hip replacement application in treatment of acetabular fractures in elderly patients

随着人口老年化的进程,低能量损伤所致的老年髋臼骨折(AF)患者逐年增加,而目前仍没有关于老年AF的治疗指南或专家共识。老年AF的治疗分为非手术治疗和手术治疗。非手术治疗因卧床相关并发症多及预期效果不理想,仅适用于无法耐受手术的患者。手术治疗是老年AF首选的治疗方案,同年轻AF以切开复位内固定术(ORIF)为金标准不同,老年AF行ORIF要慎重,因为其手术复位及固定难度更大,创伤性关节炎、股骨头坏死等并发症发生率更高,需再次行全髋关节置换术(THA)治疗,而延迟THA的效果不如初次THA,并且延迟THA手术难度高、风险大。对于具有预期结果不良的危险因素的老年AF患者,急性THA(联合或不联合ORIF)可以通过一次麻醉和一次手术实现髋关节重建,越来越多的被采用,正逐渐成为老年AF治疗的新选择。为了进一步明确THA在老年AF治疗中的应用进展,将近年来THA应用于老年AF的相关文献进行综述,详细阐述延迟THA、急性THA的适应证、手术难点及注意事项,以促进在老年AF治疗时做出最优选择。

With the aging of the population,the number of elderly patients with acetabular fracture(AF)caused by low energy injury is increasing year by year,and there is no guideline or expert consensus on the treatment of AF in the elderly.The treatment of AF in the elderly can be divided into non-surgical treatment and surgical treatment.Non-surgical treatment is only suitable for patients who cannot tolerate surgery due to many bed complications and unsatisfactory expected results.Surgical treatment is recommended for elderly acetabular fractures.Different from open reduction and internal fixation(ORIF)as the gold standard for young acetabular fractures,ORIF should be carefully performed for elderly acetabular fractures because of the greater difficulty of surgical reduction and fixation and the higher incidence of complications such as traumatic arthritis and avascular necrosis of femoral head,require delay total hip replacement(THA)treatment.The effect of delayed THA is not as good as the primary THA,and delayed THA is difficult and risky.Acute THA(with or without ORIF),which can be used for hip reconstruction with one anesthesia and one operation,is increasingly being adopted as a new treatment option for AF in elderly patients with risk factors for adverse outcomes.In order to further clarify the application progress of THA in the treatment of elderly AF,the relevant literatures of THA on the indications,surgical difficulties and precautions of delayed THA and acute THA were reviewed and expounded in detail,so as to promote the optimal selection in the treatment of elderly AF.