手术治疗复杂髋臼骨折66例临床分析  

Operative treatment of 66 patients with complex fracture of acetabulum

作　　者：李文平[1] 靳方运[1] 郭斌[1] 吴若丹[1] 刘坤[1] 卢斌[1] 白云鹤[1] 安灵芝[1] 

机构地区：[1]焦作市人民医院骨科,河南焦作454002

出　　处：《中国骨伤》2007年第1期20-21,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的：研究复杂髋臼骨折的手术适应证、手术时机、并发症及内固定方法的选择和操作要点。方法：66例髋臼骨折患者中男58例，女8例；年龄22～61岁，平均35．5岁。新鲜骨折63例，陈旧性骨折3例。所有患者均采用切开复位内田定冶疗，其中40例采用后方切口，20例前方切1：7，6例采用前后联合切1：7。36例采用髋臼钢板固定，26例采用单纯加压螺钉固定，4例采用钢板内固定结合克氏针固定。63例伤后5～10d内施行手术，3例伤后14d手术。术后穿“丁”字鞋2—3周，术后3～5d用CPM机遂渐被动关节功能锻炼，8～12周后恢复负重活动。结果：随访58例，时间24～110个月，平均30个月。5例发生不同程度的异位骨化，4倒发生股骨头坏死，2例发生深静脉栓塞。参照美国矫形外科研究院评价标准，优33例，良16例，可6例，差3例。优良率84．5％。结论：复杂髋臼骨折的手术治疗要掌握手术适应证，把握良好的手术时机，选择合适的内固定方法，尽量采用无创技术，对改善临床疗效十分重要。Objective：To study surgical indications,surgical opportunities,postoperative complications and choice of interhal fixation methods and its pedorming key-polnts for complex fracture of acetabulum. Methods： Sixty-six patients including 58 male and 8 ferule,with an average age of 35.5 years ranging from 22 to 61 years,were recruited in the present study. Among all 66 patients 63 suffered from fresh fracture and 3 got old fracture. All the patients were treated with open reduction and internal fixation,in which 40 patients were treated with posterior approach,20 with anterior approach and 6 with posterior approach combination with anterior approach. Acetabular reconstruction plate fixation was used in 36 patients,simple compress screw in 26 patients and reconstruction plate internal fixation plus Kirchner fixation in 4 patients. The operation was performed in 63 patients within 5 to 10 days after injury,3 patients at 14th day after injury. After operation,T shape shoes were used for 2 to 3 weeks, postoperative passive functional exercise was practiced 3 to 5 days after operation by using CPM, and weight bearing activity started from 8 to 12 weeks after operation. Results： Fifty-eight patients were followed up with art average time of 30 months ranging from 24 to 110 months. Postoperative complications included heterotopic ossification to different degree in 5 patients, femoral head necrosis in 4 patients, and deep venous embolism in 2 patients. According to the criteria of USA Academy of Orthopedic Surgery, excellent results achieved in 33 patients, good in 16, fair in 6 and poor in 3. The excellent and good rate wets 84. 5%. Conclusion：Follow points will be benefit to improve clinical effects in the treatment of complex fracture of aeetabalum：grasp of surgical indications,correct choice of the operation time and suitable internal fixation method,as well as application of noninvasive technique.

关 键 词：髋骨折 髋臼 骨折固定术 内 

分 类 号：R683.3[医药卫生—骨科学]