复杂髋臼骨折的手术治疗  

Operative Treatment of Complex Acetabular Fractures

作　　者：顾琪珊[1] 班照楠[1] 彭晓[1] 赵耘[1] 杨静[2] 

机构地区：[1]成都市第五人民医院骨科,四川成都611130 [2]四川大学华西医院骨科,四川成都610041

出　　处：《华西医学》2009年第4期840-842,共3页West China Medical Journal

摘　　要：目的：探讨复杂髋臼骨折的手术治疗方法及与疗效。方法：总结2002年2月-2007年12月对20例复杂髋臼骨折手术治疗的经验。其中男性14例,女性6例;年龄18-58岁,平均41岁。术前根据X线片及CT检查结果,所有骨折均按Letournel-Judet的方法进行分型、复合型20例。根据不同骨折类型,分别采用Kocher-Langenbeck入路10例,髂腹股沟入路4例及前后联合入路6例进行复位、固定。平均手术耗时3.5 h,术中平均失血900 mL。结果：所有患者术后随访时间12-48个月,平均30个月。根据Matta影像学评分,解剖复位12例,复位满意4例,复位不满意4例。根据美国矫形外科学会髋关节功能评价标准,关节功能优6例,良8例,差6例,优良率为70%。解剖复位加满意复位的临床优良率为78.5%,而满意复位和差的复位的优良率为25%（P〈0.05）。结论：不同的髋臼骨折需采用不同开放复位策略,其选择决定于髋臼骨折的类型,移位方向及其相应的手术入路。解剖复位、牢固固定、早期功能锻炼是提高疗效的关键。Objective： To discuss the method for operative treatment of complex acetabular fractures and assess corresponding results. Methods： Totally 20 cases of complex acetabular fractures treated operatively＇from February 2002 to December 2007 were reviewed. There were 14 males and 6 females, with an average age of 41 years （18 to 58）. On the basis of X-ray and computed tomography, all fractures were classified according to the Letournel-Judet classification, 20 cases were complicated fractures. Kocher-Lange beck approach （10 cases）, illiomguinal approach （4 cases） and anterior combined posterior approach （6 cases） were adopted for different fractures with reconstruction plates and screws. The mean operation time was 210 min. The average blood loss was 900 mL. Results： All cases were followed up for average 30 months （12 to 48 months）. According to the criteria of matte radiographic grade, there were 12 cases with anatomic reduction, 4 with satisfactory reduction,4with unsatisfactory reduction. An excellent and good result was attained in 70% of the patients according to the American Academy of Orthopedic Surgery （AAOS） Score （6 cases as fine, 8 cases as fair and 6 cases as poor）. The excellent and good rate for anatomic and satisfactory reduction groups were 78.5%, while satisfactory and unsatisfactory reduction were 25%（P〈0.05）. Conclusion： The different method of open reduction should be taken for different fracture of the acetabulum. The exit methods of the reduction are determined by the fracture type and its displacement direction as well as the operative approach. Anatomic reduction, firm fixation and early functional rehabilitation are essential for reaching a good clinical result of acetahnlar fracture.

关 键 词：髋臼骨折 分型 手术入路 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]