大转子后半截骨在髋臼骨折手术显露中的应用  

Posterior trochanteric osteotomy provides adequate exposure for treatment of acetabular fractures

作　　者：牛云飞[1] 许硕贵[1] 张春才[1] 刘欣伟[1] 曹烈虎[1] 王攀峰[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：《中华创伤骨科杂志》2011年第1期12-15,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨大转子后半截骨在涉及臼顶后上部的髋臼骨折手术显露中的作用.方法 2000年1月至2008年1月收治32例涉及臼顶后上部的髋臼骨折患者,其中28例获得随访,男16例,女12例;平均年龄39.9岁（16～73）岁;新鲜骨折19例,陈旧性骨折9例.所有患者均采用大转子后半截骨入路进行显露,采用髋臼三维记忆内固定系统固定髋臼骨折及大转子截骨块.结果 28例患者术后获平均48.9个月（19～95个月）随访.根据Matta标准：解剖复位17例,满意复位10例,不满意复位1例.所有髋臼骨折均一期愈合,未出现骨折移位.所有截骨块均获骨性愈合,平均愈合时间为14周.无骨不连、截骨块近端移位、内固定松动、断裂及深部感染等并发症发生.其中1例患者髂腹股沟切口发生浅表感染,经定期换药后切口二期愈合;2例患者骨折愈合后出现内固定刺激征,术后6个月取出大转子部位内固定.外展肌力根据美国医学研究委员会分级系统评定：4级3例,3级1例,其余患者肌力末受明显影响.采用d＇Aubigne ＆ Postel 临床分级标准评定髋关节功能：优10例,良15例,可2例,差1例,优良率为89.3%.结论 大转子后半截骨入路能够提供可靠的臼顶后上部显露,可以满足髋臼骨折的复位要求.Objective To explore whether posterior trochanteric osteotomy can provide adequate exposure to facilitate surgery for acetabular fractures.Methods From January 2000 to January 2008, 32 cases of acetabular fracture involving the acetabular dome underwent posterior trochanteric osteotomy for a better exposure to facilitate internal fixation with acetabular tridimensional memory fixation system（ATMFS）.Of the 32 cases, 28 were followed up.They were 16 men and 12 women, with a mean age of 39.9 years （16 to 73） .There were 19 fresh fractures and 9 old ones.Results Twenty-eight cases were followed up for an average of 48.9（ 19 to 95） months .According to Matta criteria, anatomical reduction was achieved in 17 cases, satisfactory reduction in 10 cases, and unsatisfactory reduction in one old fracture.All the fractures got direct bony union with no displacement or deep infection.All the osteotomy fragments healed within 14 weeks without any nonunion, proximal migration, loosening or breakage of hardware or deep infection.Superficial infection occurred in one patient but healed after regular dressing.Two patients had to sustain removal of the implants from greater trochanter because of irritation.According to the Medical Research Council （MRC） grading system, the strength of the abductors was of Grade 4 in 3 patients, of Grade 3 in one patient and normal in the rest.By the modified d＇Aubigne ＆ Postel scoring system, the excellent to good rate was 89.3%.Conclusion Posterior trochanteric osteotomy can provide an adequate exposure of the acetabular dome without such complications as nonunion, proximal replacement or weakness of the abductors which often occur after the conventional oblique osteotomy.

关 键 词：髋臼 骨折 截骨术 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]