Factores pronóstico en el tratamiento quirúrgico de las fracturas de acetábulo

• Requena Ruiz, Francisco Manuel ^[1] ; Montes Torres, Cristina ^[1] ; Arjona Giménez, Carlos ^[1]
  1. [1] Hospital Universitario Virgen de las Nieves

     Hospital Universitario Virgen de las Nieves

     Granada, España

     
• Localización: Revista de la Sociedad Andaluza de Traumatología y Ortopedia, ISSN-e 1578-9756, Vol. 36, Nº. 2, 2019, págs. 18-27
• Idioma: español
• Títulos paralelos:
  • Prognostic factors in the surgical treatment of acetabular fractures
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivo. Variables pronóstico en las fracturas de acetábulo tratadas de manera quirúrgica. Material y métodos. De la base de datos de nuestro hospital se analizaron 47 pacientes tratados de fractura de acetábulo de manera quirúrgica en los últimos 10 años. El seguimiento mínimo tras la cirugía fue de 2 años mediante valoración clínica, según la escala funcional Harris Hip Score, y radiológica mediante radiografía simple y/o tomografía computarizada. Resultados. Se analizaron las variables edad, sexo, mecanismo de acción, clasificación de la fractura según Letournel, cuerpos libres prequirúrgicos, tiempo hasta la cirugía definitiva, tipo de abordaje, calidad de la reducción y osificación heterotópica. Observamos que el aumento de la edad está íntimamente relacionada con la implantación de artroplastia total de cadera en los 2 primeros años tras la cirugía (p=0.045). Demostramos peores resultados funcionales en pacientes con presencia de osificación heterotópica y pacientes de edad más avanzada (p=0.016 y p<0.001, respectivamente). Además se observó mejor calidad de la reducción en aquellas fracturas tratadas mediante un único abordaje (p=0.012). Conclusión. Los pacientes de edad avanzada, la utilización de abordaje combinados y la presencia de osificacion heterotópica influyen negativamente en el pronostico funcional y aumentan la probabilidad de una futura conversión a artroplastia primaria de cadera.

  • English

    Objectives. Prognostic variables in acetabular fractures treated surgically. Material and Methods. Forty-seven patients with acetabulum fractures surgically treated in our center during the last ten years were retrospectively clinically analyzed following the Harris Hip Score Functional Scale and radiologically by means of straight x-rays and ct-scans. The minimum follow-up period was two years. Results. We analyzed the variables age, sex, mechanism of action, classification of the fracture according to Letournel, intra-articular foreign bodies, time to definitive surgery, type of approach, quality of reduction and heterotopic ossification. We observed that the increase in age is closely related to the implantation of total hip arthroplasty in the first 2 years after surgery (p = 0.045). We showed worse functional results in patients with presence of heterotopic ossification and older patients (p = 0.016 and p <0.001, respectively). In addition, better quality of the reduction was observed in those fractures treated by a single ap-proach (p = 0.012). Conclusions. There are factors to be considered in the surgical management of acetabulum fractures. It is preferable that this type of fractures were treated in reference centers.

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