髋臼骨折术后疗效相关影响因素分析  

ANALYSIS OF RESULT AND INFLUENCE FACTORS OF OPERATIVE TREATMENT OF ACETABULAR FRACTURES

作　　者：智春升[1] 李忠强[1] 杨晓松[1] 范树枫 

机构地区：[1]沈阳市骨科医院骨瓮髋臼外科,沈阳110044

出　　处：《中国修复重建外科杂志》2011年第1期21-25,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过分析髋臼骨折手术治疗患者资料,探讨影响髋臼骨折术后髋关节功能恢复的相关因素。方法回顾分析2004年9月-2009年6月收治并获随访的82例髋臼骨折患者临床资料。男65例,女17例;年龄26～72岁,平均38岁。致伤原因:交通事故伤62例,压砸伤13例,高处坠落伤7例。其中70例受伤至入院时间为30 min～12 d,中位时间7.6 h;12例于外院保守治疗34～67 d,效果欠佳转院。根据Judet等分型标准:后壁骨折24例,后柱骨折3例,前壁骨折1例,前柱骨折2例,横形骨折6例,横形伴后壁骨折16例,后柱伴后壁骨折4例,T形骨折5例,前方伴后半横形骨折3例,双柱骨折18例。其中24例合并髋关节脱位。术中分别采用Kocher-Langenbeck入路(49例)、髂腹股沟入路(19例)、前后联合入路(14例),以骨盆重建钢板(74例)和空心拉力螺钉(8例)对骨折行内固定。术后髋关节功能按照改良的Merled’ Aubigne-Postel评分系统进行评定,并按照骨折类型、年龄、术前是否合并下肢骨折、手术时机、骨折复位质量、有无髋关节脱位及复位时间、手术入路、手术前后是否合并下肢深静脉血栓形成(deep vein thrombosis,DVT)及术后是否出现异位骨化(heterotopic ossification,HO)进行分组比较。结果患者骨折复位情况按Matta评定标准,获解剖复位21例,良好复位37例,一般复位16例,差复位8例,优良率为71%。患者术后均获随访,随访时间12～52个月,平均34个月。术中发生医源性坐骨神经损伤8例,术后发生切口感染3例、HO 16例、DVT 3例、创伤性关节炎12例、股骨头缺血性坏死9例。X线片检查示,80例骨折于术后10～24周愈合,平均14周;2例骨折于术后10个月和12个月延迟愈合。术后6个月髋关节功能获优26例,良32例,一般20例,差4例,优良率为71%。骨折类型、年龄、术前是否合并下肢骨折、骨折复位质量、手术时机、有无髋关节脱位及复位时间7个因素比较,差异均有�Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors.Methods The clinical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009.Of 82 patients,65 were male and 17 were female,aged 26-72 years（mean,38 years）.Fractures were caused by traffic accident in 62 cases,by crush in 13 cases,and by falling from height in 7 cases.The time from injury to admission was 30 minutes to 12 days（median,7.6 hours） in 70 cases,12 cases were transferred because poor result after 34-67 days of conservative treatment.According to Judet classification,there were 24 cases of posterior wall fracture,3 cases of posterior column fracture,1 case of anterior wall fracture,2 cases of anterior column fracture,6 cases of transverse fracture,16 cases of transverse and posterior wall fracture,4 cases of posterior column and posterior wall fracture,5 cases of T-type fracture,3 cases of anterior and posterior hemitransverse fracture,and 18 cases of complete both-column fracture;24 cases combined with dislocation of the hip.During operation,Kocher-Langenbeck approach was used in 49 cases,anterior ilioinguinal approach in 19 cases,and the combination of anterior and posterior approaches in 14 cases.Reconstructive plate（74 cases） and hollow lag screw（8 cases） internal fixation were used.The function of the hip was evaluated according to the modified Merled’Aubigne-Postel hip score system postoperatively.According to fracture type,age,lower extremity fracture before operation,quality of reduction,timing of surgery,hip dislocation and time of reduction,operative approach,deep vein thrombosis（DVT）,and heterotopic ossification（HO）,the patients were divided into the groups and the results were compared.Results Accordance with the Matta X-ray evaluation criteria,anatomic reduction was achieved in 21 cases,good reduction in 37 cases,fair reduction in 16 cases,and poor reduction in 8 cases,and the ex

关 键 词：髋臼骨折 手术治疗 疗效 影响因素 

分 类 号：R687.3[医药卫生—骨科学]