切开复位内固定术联合全髋关节置换术治疗老年髋臼骨折

Open reduction and internal fixation combined with total hip arthroplasty for acetabular fractures in the elderly

目的探讨采用切开复位内固定术联合全髋关节置换术治疗老年髋臼骨折的临床疗效。方法回顾性分析自2019-01—2020-06采用切开复位内固定术联合全髋关节置换术治疗的6例老年髋臼骨折,术中尽量做到微创复位内固定恢复骨折稳定性,然后再置入假体,不过分追求解剖复位。结果本组手术均顺利完成,手术时间为150~280 min,平均203 min;失血量为975~2362 mL,平均1394 mL。6例均获得随访,随访至术后24个月。所有患者随访过程中均未发生假体脱位、假体周围骨折、切口感染及其他不良事件,原骨折处均获得较好的愈合。末次随访时6例均可独立行走,其中3例不需要使用辅助工具,2例需使用手杖,1例需使用助行器,所有患者均对术后疗效满意。本组术后24个月髋关节功能Harris评分平均为83.3(75~92)分,简明肌肉骨骼功能SMFA评分中功能障碍指数平均为22.7(16~35)分,SMFA评分中烦恼指数平均为21.3(11~31)分,EQ-5D量表评分平均为0.72(0.58~0.88)分。结论一期采用切开复位内固定术联合全髋关节置换术治疗老年髋臼骨折效果满意,术后既可获得良好的运动功能恢复和影像学结果,有助于患者早期负重行走,尤其适用于骨质疏松严重的患者,又可避免因切开复位内固定术后创伤性关节炎或股骨头缺血性坏死等并发症而行二次手术的风险。

Objective To investigate the clinical effect of open reduction and internal fixation combined with total hip arthroplasty for treatment of acetabular fractures in the elderly.Methods Six elderly patients with acetabular fractures treated with open reduction and internal fixation combined with total hip arthroplasty from January 2019 to June 2020 was retrospectively analyzed.During the operation,minimally invasive reduction and internal fixation was firstly conducted to restore the stability of fractures,and anatomic reduction was not excessively pursued.Then total hip arthroplasty was subsequently conducted.Re⁃sults The operation time was 150-280 min,with an average of 203 min.The blood loss was 975-2362 mL,with an average of 1394 mL.All 6 patients were followed up for 24 months postoperatively without dislocation,periprosthesis fracture,infection and other adverse events,and the fracture healed well.At the last follow-up,3 of them could walk independently without aids,while 2 needed hand canes,and 1 needed walking frame.All 6 patients were satisfied with the postoperative effects.At 24 months after surgery,the mean Harris hip score was 83.3(75-92),the mean SMFA dysfunction score,the bother score,and the mean EQ-5D index score were 22.7(16-35),21.3(11-31)and 0.72(0.58-0.88),respectively.Conclusion The outcome of one-stage open reduction and internal fixation combined with total hip arthroplasty for the treatment of acetabular fractures in the elderly is satisfactory.After operation,good functional and radiological results can be obtained,which are helpful to walk with load earlier,especially for patients with severe osteoporosis.In the meanwhile,the risk of reoperation due to traumatic arthritis or femoral head necrosis after open reduction and internal fixation can be avoided.