Objective To analyze the risk factors of periprosthetic acetabular fracture in total hip arthroplasty (THA) and to discuss the prevention and management.Methods A total of 1 023 patients (1 168 hips) undergoing THA were retrospectively analyzed between January 2012 and June 2015.There were 421 males (507 hips) and 602 females (661 hips),aged from 23 to 96 years with mean age of 64.2± 15.0 years.Primary total hip arthroplasty was conducted in 1 053 hips,while revision surgery was conducted in 115 hips.The reasons of periprosthetic acetabular fracture were summarized.Age,gender,BMI,primary disease,left or right sides,surgical approach,osteoporosis,prosthetic type,the coverage rate of acetabulum-bone,and the amount of surgical operation annually were compared between non-fracture and fracture.Risk factors associated with the fracture were analyzed using chi square test followed by a multivariate logistic regression.Furthermore,revision surgery was compared with primary THA using chi square test.Results The incidence of intraoperative periprosthetic acetabular fractures was 2.8％ (33/1 168).The incidence of fracture was higher in revision surgery than that in primary THA (6.1％ vs.2.5％).Multivariate logistic regression showed that primary disease (developmental dysplasia of the hip and rheumatoid arthritis),osteoporosis,uncemented acetabular cup,the high-er coverage rate of acetabulum-bone,and the less amount of surgical operation annually were prone to appear periprosthetic acetabular fracture in primary THA.Among the 33 patients with acetabular fractures,13 cases (39.4％,13/33) were found intraoperatively and 20 cases (60.6％,20/33) postoperatively.Acetabular wall fractures were in 26 (78.8％,26/33),column fractures in 2 (6.1％,2/33),transverse fractures in 2 (6.1％,2/33) and quadrilateral surface fractures with prosthetic central dislocation in 3 (9.1％,3/33).Seven cases of 26 stable fractures and 6 cases of 7 unstable fractures were found intraoperatively.Acetabular wall fractures were fixed by additional augmentation screws or accepted no special treatment,and column fractures were fixed with plate.One quadrilateral surface fracture was accepted revision surgery using Jumbo cup,2 quadrilateral surface fractures and 2 transverse fractures with reconstruction cage.The patients were followed up for 42.3±13.7 months (range 29-60 months).The Harris hip score was 83.3±6.6 (range 72-94) at last follow-up.No complication,such as hip dislocation,osteolysis,and prosthetic loosening was reported.Conclusion Most of periprosthetic acetabular fiactures are wall fractures which could not endanger the periprosthetic stability.The detection rate of acetabular stable fracture is lower than that of unstable fracture in operation.Primary disease (developmental dysplasia of the hip and rheumatoid arthritis),osteoporosis,uncemented acetabular cup,the higher coverage rate of aeetabulum-bone,the less amount of surgical operation annually are the intraoperative risk factors which closely related to acetabular fractures of primary THA.The risk of intraoperative periprosthetic acetabular fractures in revision THA is higher than that in primary THA.%目的 探讨全髋关节置换术中髋臼假体周围骨折的危险因素、骨折特点及处理方法.方法 回顾性分析2012年1月至2015年6月接受全髋关节置换术的患者1 023例(1 168髋),男421例(507髋),女602例(661髋);年龄23～96岁,平均(64.2±15.0)岁.初次全髋关节置换1 053髋,全髋关节翻修115髋.对初次置换术中发生髋臼假体周围骨折患者的年龄、性别、体重指数、侧别、原发疾病、手术入路、髋臼骨质疏松、假体类型、假体骨性覆盖率等相关因素行单因素及Logistic回归分析,筛选初次全髋关节置换术中髋臼假体周围骨折的独立危险因素.通过卡方检验分析初次置换和翻修术中髋臼假体周围骨折发生率的差异.结果 髋关节置换术中髋臼假体周围骨折的总体发生率为2.8％(33/1 168).翻修术中髋臼假体周围骨折发生率为6.1％(7/115),高于初次置换术的2.5％(26/1 053),差异有统计学意义(x2=4.943,P=0.026).多因素Logistic回归分析中,原发疾病(发育性髋关节发育不良或类风湿关节炎)、骨质疏松、生物型髋臼杯、假体骨性覆盖率高、医生年手术量少是初次全髋关节置换术中髋臼假体周围骨折发生的危险因素.髋臼假体周围骨折33髋中,于术中发现13髋(39.4％,13/33);术后发现20髋(60.6％,20/33),髋臼壁骨折26髋(78.8％,26/33)、髋臼柱骨折2髋(6.1％,2/33)、髋臼方形区骨折伴假体中心性脱位3髋(9.1％,3/33)、髋臼横形骨折2髋(6.1％,2/33).假体稳定性骨折26髋(78.8％,26/33),术中检出率26.9％(7/26);非稳定性骨折7髋(21.2％,7/33),术中检出率85.7％(6/7).髋臼壁骨折采用螺钉加强固定或保守治疗,髋臼柱骨折采用钢板固定,髋臼方形区骨折伴假体中心性脱位采用Jumbo杯翻修1髋、金属重建杯2髋,髋臼横形骨折采用金属重建杯.33髋均获得随访,随访29～60个月,平均(42.3±13.7)个月.末次随访时Harris髋关节评分72～94分,平均(83.3±6.6)分.无髋臼假体周围骨溶解、髋关节脱位和假体松动等术后并发症发生.结论 髋臼假体周围骨折主要发生于髋臼壁,不影响假体稳定性.假体稳定性髋臼骨折术中检出率较低,而假体非稳定性骨折检出率高.发育性髋关节发育不良、类风湿关节炎、骨质疏松、生物型髋臼杯、假体骨性覆盖率高、医生手术量少是术中髋臼骨折的独立危险因素.翻修术中髋臼假体周围骨折的发生率高于初次关节置换.
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