Zusammenfassung
Hintergrund: Spätfolgen wie Coxarthrose, Hüftkopfnekrose und periartikuläre Ossifikationen (PAO)
können das Outcome nach Azetabulumfrakturen trotz guter Reposition einschränken. In
dieser Studie wurden Behandlungsergebnis sowie die Ausprägung von PAO in Abhängigkeit
des Frakturtyps und des operativen Zugangsweges analysiert. Besonderes Interesse galt
der Frage, inwieweit durch Verringerung des begleitenden Weichteilschadens ein besseres
Outcome erreicht wird. Patienten und Methoden: Insgesamt wurden 55 Patienten nachuntersucht: Durchschnittsalter 40,4 Jahre (20-81
J), Untersuchungsintervall 7,7 J (4,4-12,3 J) und Geschlechtsverteilung (M 43/W 12).
Die Frakturen wurden gemäß der AO eingeteilt, das funktionelle Ergebnis nach D'Aubigné-Postel
ermittelt und die Ausprägung der Ossifikationen nach Brooker bestimmt. Ergebnisse: Verteilung der Frakturen nach AO: Typ A: 24 (44 %), Typ B: 23 (42 %) und Typ C: 8
(15 %). Der mittlere D'Aubigné-Postel-Index war insgesamt 15,2 Punkte (max. 18) und
wie folgt auf die Frakturtypen verteilt: Typ A 15,9, Typ B 15,0 und Typ C 13,6 Punkte.
Die Häufigkeit der PAO nach Brooker war: Grad 0 - 32 %, Grad I - 10 %, Grad II und
Grad III jeweils 29 %, dabei fielen 2/3 der Brooker-III-Ossifikationen auf die Gruppen
mit erweiterten Zugängen und auf Typ-C-Frakturen. Brooker VI sahen wir nicht. Tendenziell
wurden beim iliofemoralen Zugang weniger Ossifikationen beobachtet als bei den kombinierten
Zugängen. Schlussfolgerung: Der Minimierung des Operationstraumas kommt eine besondere Bedeutung zu. Aufgrund
des höheren Risikos von Implantatfehllagen oder ungenügender Reposition durch die
geringere intraoperative Exposition des Hüftgelenkes sollte postoperativ eine CT durchgeführt
werden, um die Reposition und Osteosynthese zu überprüfen.
Abstract
Background: Arthrosis, necrosis of the femoral head and heterotopic ossification (HO) tend to
decline the outcome of acetabular fractures despite of good fracture reduction. In
this study functional outcome and degree of HO were analyzed due to fracture type
and surgical approach. The aim of this study is to delineate wether minimization of
soft tissue damage increases the functional outcome. Patients and methods: 55 patients with surgically treated acetabular fractures (mean age: 40.4 (20-81)
years, male 43, female 12) where retrospectively evaluated with a mean follow-up of
7.7 (4.4-12.3) years. Fractures were classified according to the Orthopaedic Trauma
Association (OTA), functional outcome was scored by D'Aubigné-Postel and the degree
of HO was defined by Brooker's classification. Results: Following the OTA the distribution of fractures was: A-24 (44 %), B-23 (42 %) and
C-8 (15 %). Mean D'Aubigné Index (max. 18 points) was 15.2, distributed to fracture
type: A-15.9, B-15.0 and C-13.6. 32 % of all heterotopic ossifications were classified
as Brooker 0, 10 % as Brooker 1, 29 % as Brooker 2 and Brooker 3 each, whereas Brooker
4 ossifications were not observed. 2/3 of the severe ossifications were observed using
extended approaches or in case of type C fractures. The iliofemoral approach showed
the tendency of fewer ossifications compared to extended approaches. Conclusion: Decrease of soft tissue damage during acetabular surgery plays an important role
to improve outcome. Due to the higher risk of wrong implant position and insufficient
reduction using a soft tissue sparing approach, we recommend a CT scan postoperatively
to evaluate reduction and osteosynthesis.
Schlüsselwörter
Azetabulumfrakturen - heterotope Ossifikationen - operative Therapie - Langzeitergebnisse
Key words
acetabular fractures - heterotopic ossification - operative treatment - long-term
results
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Dr. med. Bernd Roetman
BG-Kliniken Bergmannsheil · Universitätsklinik · Chirurgische Klinik und Poliklinik
Bürkle-de-la-Camp-Platz 1
44789 Bochum
Phone: 02 34/3 02 35 75
Fax: 02 34/3 02 65 42
Email: bernd.roetman@rub.de
