Introduction. Management of acetabular fractures is challenging, especially when a medial acetabular fracture is complicated by central hip dislocation. We retrospectively investigated the clinical outcome and risk factors of secondary hip osteoarthritis requiring total hip arthroplasty after the surgical treatment of acetabular fractures with central hip dislocation. Materials and Methods. The medical records of all patients who had acetabular medial wall fractures with central hip dislocation treated with open reduction and internal fixation by a single surgeon between January 2015 and June 2017 were reviewed. Surgical reduction was performed with the modified Stoppa with/without the Kocher-Langenbeck (KL) approach. Patients were followed for a minimum of three years, and the Majeed scoring system was used for functional evaluation. Multivariate logistic regression analysis was used to assess the association of patients’ characteristics with the likelihood of advanced posttraumatic arthritis developing with conversion to total hip arthroplasty. Results. Fifty patients were included in this study, with disease classified as AO/OTA 2018 62B/62C. Thirty-five patients (70%) had good or excellent Majeed pelvic scores. Eleven patients (22%) eventually received total hip arthroplasty because of end-stage posttraumatic arthritis. Three risk factors identified for total hip arthroplasty were male sex, initial marginal impaction, and sciatic nerve injury. Kaplan-Meier survivorship analysis estimated that the cumulative probability of free-from-end-stage arthritis was 78% (95% confidence interval, 73%–90%) at the 5-year follow-up. Conclusion. Surgical fixation with the modified Stoppa and the KL approach for acetabular medial wall fractures with central hip dislocation is an effective approach with a satisfactory functional outcome. A prodromal factor was marginal impaction concomitant with articular damage. The trauma of high axial loading and the occupational distribution (males performing heavy manual labor and heavy lifting) with preoperative sciatic nerve injury increased the odds of developing end-stage arthritis.

中文翻译：

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髋臼骨折伴中央髋关节脱位：中期随访中基于 AO/OTA 2018 分类的回顾性连续 50 例病例系列研究

简介。髋臼骨折的处理具有挑战性，尤其是当髋臼内侧骨折合并中央髋关节脱位时。我们回顾性调查了髋臼骨折合并髋关节中央脱位手术治疗后需要全髋关节置换术的继发性髋骨关节炎的临床结果和危险因素。材料和方法. 回顾了2015年1月至2017年6月间单外科医生切开复位内固定治疗的所有髋臼内壁骨折合并髋关节中心脱位患者的病历。使用改良的 Stoppa 进行手术复位，有/没有 Kocher-Langenbeck (KL) 方法。对患者进行至少三年的随访，并使用 Majeed 评分系统进行功能评估。多变量逻辑回归分析用于评估患者特征与转为全髋关节置换术发展为晚期创伤后关节炎的可能性之间的关联。结果. 本研究纳入 50 名患者，疾病分类为 AO/OTA 2018 62B/62C。35 名患者 (70%) 的 Majeed 骨盆评分良好或优异。由于终末期创伤后关节炎，11 名患者（22%）最终接受了全髋关节置换术。确定全髋关节置换术的三个危险因素是男性、初始边缘嵌塞和坐骨神经损伤。Kaplan-Meier 生存分析估计，在 5 年的随访中，无终末期关节炎的累积概率为 78%（95% 置信区间，73%–90%）。结论. 改良 Stoppa 手术固定和 KL 入路治疗髋臼内壁骨折伴中央髋关节脱位是一种有效的方法，功能效果令人满意。前驱因素是伴随关节损伤的边缘嵌塞。高轴向负荷的创伤和职业分布（男性进行繁重的体力劳动和举重）与术前坐骨神经损伤增加了发生终末期关节炎的几率。