背景:髋臼骨折后的全髋关节置换术(THA)通常在初次保守治疗后的几个月或几年后进行。但THA可在骨折切开复位内固定(ORIF)后更早进行。这项研究的目的是确定哪种策略是最好的。主要结局指标是髋关节旋转中心(COR)的放射学恢复。次要结果指标是并发症发生率和髋关节功能评分。Mat.方法:将多中心队列分为三组:A组(THA在骨折3周内);B组(THA在早期ORIF后延迟);C组(THA在骨折后3周以上,没有ORIF)。B组分为B-(THA小于ORIF后1年)和B+(THA大于ORIF后1年)两个亚组。人口统计,外科技术,COR优越和侧向迁移系数和功能评分(HHS,记录HOOS-PS和FJS)。使用PROM收集功能评分。
结果:总之,纳入367例患者:A组108例,B组69人,B+组113例,C组77例。平均随访5.8年[3.4个月-35年]。患者的平均年龄为69.2岁[SD15;26-101],52年[SD16;19-83],49年[SD16;16-85]和58.1年[SD17;13-94],分别(p<0.01)。平均ASA评分为2.13[SD0.70],1.84[SD0.65],1.67[SD0.63]和1.79[SD0.60],分别(p<0.01)。63例患者(61%)出现复杂的Letournel骨折,46例(71%),48例患者(49%)和38例患者(62%),分别(p<0.01)。38例患者(69%)植入了加固笼,16例(62%),5例患者(12%)和19例患者(66%),分别(p<0.01)。45例患者(45%)使用水泥,23名患者(35%),19例患者(18%)和21例患者(32%),分别(p<0.01)。46例患者(46%)需要移植,35名患者(53%),17例患者(16%)和21例患者(48%),分别(p<0.01)。40例患者(46%)进行了后路ORIF,32例(55%),64例(61%)和9例(82%),分别(p<0.01)。C组的COR侧向迁移系数明显高于其他组(p=0.02),平均值为0.17(SD0.85)[-0.27至6]。COR优越的迁徙系数组间具有可比性,平均值为+0.77(SD2.26)[-0.99至27],p>0.05。10例(9.2%)出现并发症,6例(8.7%),6例(5.3%)和3例(3.9%),分别,组间无显著差异。51%的患者完成了PROM。在最后的审查中,在整个队列中,平均HHS为79.2(SD21.8),平均HOOS-PS为77.7(SD20.1),p>0.05。各组的平均FJS为55.9(30.2),47.7(标准差36.4),66.1(SD30.4)和65.8(SD30.3),分别(p=0.02)。
结论:B策略(B+)在功能和COR恢复方面产生了良好的结果。当使用这个策略时,前ORIF通过后入路保留了随后的THA的天然髋关节。策略C也会产生良好的功能结果,但会横向改变COR。这项研究证实了以前出版物中策略A的不良结果。当预后较差时,在前ORIF和THA后1年内立即动员似乎是一个很好的策略(B-组).
方法:IV,观察性研究。
BACKGROUND: Total hip arthroplasty (THA) after acetabular fracture is typically performed months or years later for posttraumatic arthritis after initial conservative treatment. But THA can be performed earlier after open reduction and internal fixation (ORIF) of the fracture. The aim of this study was to determine which strategy is best. The primary outcome measure was the radiological restoration of the hip\'s center of rotation (COR). The secondary outcome measures were the incidence of complications and the hip\'s functional scores.
METHODS: A multicenter cohort was analyzed by splitting patients into three groups: group A (THA within 3weeks of fracture); group B (THA deferred after early ORIF); group C (THA more than 3weeks after fracture, without ORIF). Group B was separated into two subgroups: B- (THA less than 1year after ORIF) and B+ (THA more than 1year after ORIF). The demographics, surgical techniques, COR superior and lateral migration coefficient and functional scores (HHS, HOOS-PS and FJS) were recorded. The functional scores were gathered using PROMs.
RESULTS: In all, 367 patients were included: 108 in group A, 69 in group B-, 113 in group B+ and 77 in group C. The mean follow-up was 5.8years [3.4 months-35years]. The mean age of the patients was 69.2years [SD 15; 26-101], 52years [SD 16; 19-83], 49years [SD 16; 16-85] and 58.1years [SD 17; 13-94], respectively (p<0.01). The mean ASA score was 2.13 [SD 0.70], 1.84 [SD 0.65], 1.67 [SD 0.63] and 1.79 [SD 0.60], respectively (p<0.01). A complex Letournel fracture was present in 63 patients (61%), 46 patients (71%), 48 patients (49%) and 38 patients (62%), respectively (p<0.01). A reinforcement cage was implanted in 38 patients (69%), 16 patients (62%), 5 patients (12%) and 19 patients (66%), respectively (p<0.01). Cement was used in 45 patients (45%), 23 patients (35%), 19 patients (18%) and 21 patients (32%), respectively (p<0.01). A graft was needed in 46 patients (46%), 35 patients (53%), 17 patients (16%) and 21 patients (48%), respectively (p<0.01). Posterior ORIF was done in 40 patients (46%), 32 patients (55%), 64 patients (61%) and 9 patients (82%), respectively (p<0.01). The COR lateral migration coefficient was significantly higher in group C with a mean of +0.17 (SD 0.85) [-0.27 to +6] compared to the other groups (p=0.02). The COR superior migration coefficient was comparable between groups, with a mean of +0.77 (SD 2.26) [-0.99 to 27], p>0.05. There were complications in 10 patients (9.2%), 6 patients (8.7%), 6 patients (5.3%) and 3 patients (3.9%), respectively, with no significant difference between groups. The PROMs were completed by 51% of patients. At the final
review, the mean HHS was 79.2 (SD 21.8) and the mean HOOS-PS was 77.7 (SD 20.1) in the entire cohort, p>0.05. The mean FJS by group was 55.9 (30.2), 47.7 (SD 36.4), 66.1 (SD 30.4) and 65.8 (SD 30.3), respectively (p=0.02).
CONCLUSIONS: The B strategy (B+) yielded good outcomes in terms of function and COR restoration. When using this strategy, anterior ORIF preserves the native hip for a subsequent THA through a posterior approach. Strategy C also produces good functional outcomes but shifts the COR laterally. This study confirms the poor results of strategy A in previous publications. When the prognosis is poor, immediate mobilization after anterior ORIF followed by THA within 1year appears to be a good strategy (group B-).
METHODS: IV, observational study.