移位髋臼骨折的手术治疗  

Surgical treatment of displaced acetabular fractures

作　　者：关群 熊小江 冯世龙 骆浩 

机构地区：[1]重庆市三峡中心医院骨科,404000

出　　处：《中华创伤杂志》2007年第7期489-492,共4页Chinese Journal of Trauma

摘　　要：目的探讨移位髋臼骨折的手术治疗方法并初步探讨髋臼骨折Ⅰ期行全髋关节置换术的疗效。方法对69例髋臼骨折行手术治疗并随访63例，随访时间6～36个月，平均21．5个月。结果根据Matta对骨折复位情况的判定标准及美国矫形外科研究院髋关节功能评价标准：完全复位48例，满意复位17例，不满意4例；优40例，良18例，一般3例，差2例，优良率92％。并发切口感染1例，异位骨化6例，创伤性关节炎4例，股骨头缺血性坏死2例。髋臼骨折Ⅰ期全髋关节置换术随访6例均无感染、假关节松动、创伤性关节炎等并发症。结论手术是治疗移位髋臼骨折较为有效可靠的方法。全面的影像学检查是了解髋臼骨折部位及类型的主要手段；准确了解髋臼骨折的分类是提高疗效的关键。应根据髋臼骨折的分类正确选择合适的手术入路及复位固定。髋臼骨折Ⅰ期行全髋关节置换术近期疗效满意，但要谨慎掌握手术适应证，远期疗效有待进一步观察。Objective To discuss surgical methods for displaced acetabular fractures and preliminarily study therapeutic effect of total hip replacement in treatment of acetabular fractures. Methods A total of 69 cases of acetabular fractures were surgically treated from March 2000 to January 2006, of whom 63 were followed up for 6-36 months （average 21.5 months）. Results According to the Matta＇ s standard of replacement of fracture and function of thigh joint, reduction was complete in 48 cases, satisfactory in 17 but poor in 4. Of all, 40 cases were rated as excellent, 18 good, 3 common but 2 poor, with excellence rate of 92%. There was 1 case with incision infection, 1 with heterotopic ossification,4 with complication of traumatic arthritis and 2 with avascular necrosis of the femoral head. The follow up for 6 cases showed no complications like infection, loosening of artificial joint or traumatic arthritis. Conclusions Operation is a reliable and effective method for treating displaced acetabular fractures. Full-scale radiological examination is the chief method of understanding the position and type of acetabular fractures. Exact understanding of the classification of acetabular fractures is important, which is basis for selection of operative approach and reduction. For cases of acetabular fracture, total hip replacement at one stage is an effective method, with satisfactory effect, while it＇ s remote efficacy needs further investigations.

关 键 词：髋臼 骨折 关节成形术 置换 髋 

分 类 号：R686[医药卫生—骨科学]