髋臼骨折术后并发创伤性关节炎的影响因素分析

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Abstract Objective To analyze the influencing factors of occurrence of traumatic arthritis after surgery of acetabular fractures.Methods A retrospective cohort study of acetabular fractures treated surgically from February 2005 to January 2015 was conducted.A total of 152 patients included 93 males and 59 females with average age 40.9 years(range，18～67 years)and mean follow-up 82.3 months.Patients were divided into non-traumatic arthritis group and traumatic arthritis group according to diagnostic criteria of traumatic arthritis after operation.group.Patient-related factors(age，gender，weight)，fracture-related factors(injury mechanism，type of fracture，whether combined with dislocation of hip joint，time from injury to operation，operative approach，whether there was femoral head defect，quality of reduction)and postoperative factors(time to bear weight，postoperative labor strength)were evaluated.Results 111 cases belonged to nontraumatic arthritis group including 67 males and 44 females with 55 cases age higher than 40 years and 56 cases lower than and equal to 40 years.41 cases belonged to traumatic arthritis group including 26 males and 15 females with 23 cases age higher than 40 years and 18 cases lower than and equal to 40 years.).Univariate analysis showed that age(P＝0.473)，sex(P＝0.732)，weight(P＝0.072)，injury mechanism(P＝0.441)，whether combined with dislocation of hip joint(P＝0.089)，operative approach(P＝0.113)and time to bear weight(P＝0.518)had no significant differences.There was a significant difference between the two groups including type of fracture(P＜0.001)，time from injury to operation(P＝0.016)，whether there was femoral head defect(P＝0.007)，quality of reduction(P＜0.001)and postoperative labor strength(P＝0.034).Patients of non-traumatic arthritis group had higher rate of complicated fracture，long interval between injury and operation，combined with femoral head defect，low quality of reduction and postoperative high labor strength than traumatic arthritis group.group.The multivariate analysis suggested that quality of reduction(P＜0.001)and postoperative labor strength(P＝0.039)were independent influencing factors.Rest dislocation after operation was then split into step dislocation and gap dislocation，we found that step dislocation was strongly associated with traumatic arthritis(r＝0.699)，while gap dislocation was moderately associated with traumatic arthritis(r＝0.432).Conclusion Quality of reduction and postoperative labor strength are two independent influencing factors to the occurrence of traumatic arthritis.Alleviation of step dislocation is the key to improve quality of reduction.Improving quality of reduction during operation，alleviation of step dislocation，reducing labor strength after operation are effective measures to reduce or postpone occurrence of traumatic arthritis.

Key words： acetabular fractures traumatic arthritis influencing factors

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