复杂性髋臼骨折合并同侧股骨颈骨折及多处骨折的治疗与对策  

Treatment and strategy of complex acetabular fractures with ipsilateral femoral neck fractures and multiple fractures

作　　者：张春才[1] 牛云飞[1] 禹宝庆[1] 许硕贵[1] 王家林[1] 苏佳灿[1] 张鹏[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中国骨伤》2007年第7期437-439,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探索复杂性髋臼骨折(complex acetabular fractures,CAF)合并同侧股骨颈骨折及多处骨折的治疗方法与对策。方法:2000年8月-2005年3月,收治复杂性髋臼骨折合并同侧股骨颈及多处骨折12例,男7例,女5例;年龄24～51岁,平均37.5岁,皆系高能量损伤。合并其他部位骨折23处,平均2.6处。采用改良髋臼入路,应用髋臼三维记忆内固定系统(ATMFS)、空心加压螺钉、Richard钉、交锁髓内钉、天鹅记忆接骨器(SMC)等固定骶髂关节分离、复杂性髋臼骨折、股骨颈、股骨干、胫骨干、肱骨、尺桡骨骨折。结果:术后随访6～31个月,平均13.5个月。12例复杂性髋臼骨折均获解剖复位并达骨性愈合;同侧股骨颈骨折也获解剖复位,10例达骨性愈合。术后3～7个月(平均4.6个月),髋关节功能达到健侧水平;1例出现股骨头缺血性坏死行关节置换;1例股骨头坏死合并异位骨化导致关节骨性融合。4例骶髂关节分离获解剖复位;其他23处骨折,均获骨愈合。根据髋关节功能评分标准:优3例,良6例,一般1例,差2例。结论:采用改良髋臼入路、应用髋臼三维记忆内固定系统固定髋臼骨折,同时固定股骨颈骨折及合并的多处骨折,配合术后早期的功能锻炼,可以使髋关节获得良好的功能。Objective： To explore treatment and strategy of complex acetabular fractures （CAF） with ipsilateral femoral fractures and multiple fractures. Methods. From August 2000 to March 2005,12 patients of CAF with ipsilateral femoral fractures and multiple fractures were treated in our hospital. There were 7 male and 5 female with an average age of 37.5 years （range from 24 to 51 ）. They all suffered from high-energy accidents. There were 23 accompanied fractures （mean 2. 6 places）. The modified acetabular approach was adopted and the multifarious fractures were fixed with acetabular tri-dimensional memory fixation system （ATMFS）,cannulated compression screw, Richard screw, interlocking intramedullary nail and swanlike memory connector （SMC）respectively. Results： All the patients were followed up from 6 to 31 months with the mean of 13.5 months. The acetabular fractures obtained anatomic reduction and bone union. The ipsilateral femoral neck fracturs were also reduce anatomically and bone union was obtained in 10 cases. The function of hip was recovered as good as the unaffected side within 3 to 7 months after operation （average 4. 6 months）. One case underwent total hip replacement after femoral head necrosis. Hip fusion due to femoral head necrosis and heterotopic ossification was observed in another case. Segregation of sacro-iliac joint in four cases obtained anatomic reduction and the other complicated fractures （23 places ） obtained bone union. According to scoring criterion of hip joint function,the outcome was excellent in 3 cases, good in 6, fair in 1 and poor in 2. Conclusion： Modified acetabular approach and ATMFS can be used in the treatment of CAF with ipsilateral femoral neck fractures and multiple fractures. Valid internal fixation combined with early functional exercise can obtain satisfactory function of hip joint.

关 键 词：复杂性髋臼骨折 股骨颈骨折 多处骨折 

分 类 号：R683.3[医药卫生—骨科学]