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1.
《Journal of Clinical Orthopaedics and Trauma》2021,12(6):976-982
ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients. 相似文献
2.
颗粒松质骨压紧植骨全髋关节置换术治疗创伤性髋关节炎的疗效 总被引:2,自引:0,他引:2
目的探讨颗粒松质骨压紧植骨全髋关节置换术(THA)治疗髋臼骨折继发创伤性髋关节炎的疗效。方法1998年12月-2005年5月,对15例髋臼骨折继发创伤性髋关节炎患者行颗粒松质骨压紧植骨THA,所有患者髋臼假体均采用骨水泥固定,颗粒骨均取自体骨,术后24h后开始被动活动,3个月后开始全负重锻炼。临床随访采用Harris髋关节评分(HSS)系统评分,对任何原因引起髋臼假体翻修均视为临床失败。根据Conn等影像学评价法观察颗粒骨长人情况,根据DeLee的三区法测量臼杯、骨水泥与移植骨间的界面宽度,臼杯的移位程度则依据其相对于泪点间线的距离而定。结果14例患者获得平均4.3年(1.0-7.5年)随访,HHS评分由术前平均42分(10-62分)提高到随访结束时平均84分(58-98分)。1例髋部有轻度疼痛,无患者行翻修手术。大部分髋部恢复了其正常的旋转中心,仅有2例高出对侧0.8 mm。大多数患者影像学表现稳定,2例在Ⅰ区和Ⅲ区出现进行性增宽的透亮带,1例在Ⅲ区出现非进行性增宽的透亮带。1例臼杯假体在术后7年出现明显移位(6 mm),但并没有行翻修手术。结论颗粒骨压紧植骨技术作为一种生物学髋臼重建方法,其联合THA治疗髋臼骨折后继发创伤性关节炎伴髋臼缺损的疗效令人满意,能够恢复髋关节的正常解剖和功能活动。 相似文献
3.
Mitsuhiro Morita Harumoto Yamada Osamu Hemmi Kyosuke Fujikawa 《Journal of orthopaedic science》2004,9(1):99-102
In acetabular dysplasia of the hip joint accompanied by a giant acetabular bone cyst, rotational acetabular osteotomy may cause serious complications, such as bone necrosis after surgery or fracture of the fragile acetabulum during the operation. In a patient with this condition, we performed a two-stage operation: first, autogenous bone grafting supplemented with hydroxyapatite filling, then rotational acetabular osteotomy (after new bone formation had been assured). Radiographs and CT scans showed favorable fusion of the grafted bone. Some 18 months after the second operation, arthrograms showed no inflow of contrast medium from the articular cavity into the bone cyst region, although this had been observed before treatment. Thus, an effective remodeling of bony congruency was indicated in the mobile acetabulum 5 years after the second operation. This two-stage operation appears to be useful for correcting acetabular dysplasia accompanied by a giant bone cyst and to carry a reduced risk of serious complications, such as deterioration of the articular surface of the acetabulum or necrosis of the translocated acetabulum. 相似文献
4.
在髋关节翻修术中,髋臼骨缺损的治疗具有相当的挑战性。术前的计划,缺损的辨认和稳固的重建是成功翻修手术的基础。应用自体骨和同种异体骨移植填充骨缺损,目前使用特殊的重建方法行髋臼重建已取得了一定的疗效。临床上髋关节翻修手术越来越多,因此有必要针对髋臼骨缺损建立系统的诊断和治疗程序。本文就髋臼骨缺损的分类和重建进展做一综述。 相似文献
5.
6.
移位髋臼骨折合并坐骨神经损伤 总被引:6,自引:1,他引:5
报告9例移位髋臼骨折合并坐骨神经损伤的治疗,其中单纯腓侧部损伤5例,联合腓侧部与胫侧部损伤4例。非手术治疗3例,手术治疗6例,平均随访2年,结果为手术治疗5例优良,1例可,非手术治疗2例疗效均不满意,表明手术治疗可有效复位骨折,去除神经外在压迫因素,对性质明确的神经损伤进行必要的松解和修复。本组坐骨神经损伤以腓侧部受累更为常见,腓侧部易受损伤的机理可能与某些局部解剖因素有关 相似文献
7.
《Journal of Clinical Orthopaedics and Trauma》2021,12(6):1158-1161
IntroductionAcetabular fractures in the elderly population are particularly challenging for orthopedic fracture surgeons to treat. Anterior column posterior hemitransverse (ACH) and both column (BC) fractures account for over 70% of these injuries in geriatric patients. Nonoperative management of these injuries has a mortality of about 79% and patients generally have a minimal chance of return to independent living. The aim of our study was to identify the degree of protrusio deformity geriatric patients with these injuries present with and if indirect reduction through a Stoppa approach was sufficient to improve protrusio deformity.MethodsPatients older than 60 years of age who had ACH and BC pattern acetabular fractures treated at the BIDMC in Boston, MA between 2015 and 2020 were included in this study. Pelvic AP and Judet views were reviewed at injury and each available post-operative follow up. We modified the femoral head extrusion index and used its inverse to measure the level of protrusio at each time point (-FHEI). Patient outcomes were also graded as excellent, good, fair and poor based on post-operative follow up.ResultsSixteen patients were included based on above criteria and average -FHEI at injury was 34.85% and decreased significantly to an average of 21.5% postoperatively and remained stable at all follow up points. At one year follow up (n = 2), the mean -FHEI was 18.15%. Most patients had good (4) or excellent (9) outcomes.ConclusionsWe present short term results of indirect reduction of ACH and BC acetabular fractures in geriatric patients using a PRO quadrilateral surface plate, which was largely successful in controlling the primary protrusio deformity seen in these patients. This allowed for restoration of the anterior column, with limited surgical morbidity through a relatively simple and straightforward surgical approach. 相似文献
8.
9.
T. Quesnel 《Surgical and radiologic anatomy : SRA》1998,20(6):425-429
Summary Based on the geometric model developed by Netter [11], we determined the different positions of the femoral neck during monopodal support in walking in relation to a fixed frontal plane of reference (relative anteversion). This relative anteversion ranges on average from 24° of retroversion at the beginning of support to 15° of anterversion at the end if loading. We then studied the relations possibly existing between relative anteversion and acetabular orientation on the one hand, and the orientation of the resultant of the articular stresses on the other (both being variables during monopodal support in walking). The results showed that relative anteversion is well correlated with variations of position of the acetabulum since, at most, the deviation between the respective axes did not exceed the anatomic deviation due to absolute anteversion of the femoral neck and acetabulum. Lastly, analysis of the relations obtained with the orientation of the resultant of the articular stresses allowed a better comprehension of the functional distribution of forces.
Variations de l'antéversion relative du col fémoral au cours de la marche
Résumé Nous inspirant de la modélisation géométrique développée par R. Netter dans sa thèse, nous avons déterminé les différentes positions du col fémoral au cours de l'appui monopodal de la marche par rapport à un plan frontal fixe de référence (antéversion relative). Cette «antéversion relative» s'échelonne en moyenne de 24° de rétroversion en début d'appui à 15° d'antéversion en fin d'appui. Nous avons alors étudié les relations pouvant exister entre l'antéversion relative et l'orientation de l'acétabulum, d'une part, et, d'autre part, l'orientation de la résultante des sollicitations articulaires (toutes deux variables au cours de l'appui monopodal de la marche). Les résultats nous ont montré que l'antéversion relative est bien corrélée aux variations de position de l'acétabulum puisque, au maximum, l'écart entre leurs axes respectifs ne dépasse pas l'écart anatomique du à l'antéversion absolue du col et de l'acétabulum. Enfin, l'analyse des rapports existant avec l'orientation de la résultante des sollicitations articulaires nous permet de mieux entrevoir la répartition fonctionnelle des contraintes.相似文献
10.
从1972年11月到1994年3月,401例髋臼骨折病人中的99例经手术治疗并获随访,包括30例双柱骨折,13例横骨折伴后壁骨折,9例后壁骨折,9例后柱骨折,9例前往骨折伴前壁骨折,13例T形骨折和16例横骨折.平均随访时间为7年(2~14).外科手术入路的选择,后入路53次,髂腹股沟入路23次,延长的髂股骨入路11次,放射状入路9次和结合性入路6次.复位情况用X线平片来评判,解剖复位的有59例(59.6%),接近解剖复位(<2mm的错位)的有19例(19.2%).总结果用Harris Hip Score来评判,优秀的有53例(53.5%),良好的有25例(25.3%),一般的有14例(14.1%),差的有7例(7%).并发症中,有10例(53%)为感染,7例(37%)为静脉栓塞.这些结果表明,对于错位严重的髋臼骨折,切开复位内固定是一种可以选择的治疗方法. 相似文献