复杂性髋臼骨折手术治疗中长期疗效分析  

Mid- term and Long -term Curative Effect Analysis of Surgical Treatment for Complex Acetabular Fractures

作　　者：肖玉周[1] 吴敏[1] 官建中[1] 周建生[1] 刘振华[1] 刘泉[1] 周新社[1] 张长春[1] 

机构地区：[1]蚌埠医学院第一附属医院骨科组织移植安徽省重点实验室,安徽蚌埠233004

出　　处：《解剖与临床》2011年第4期286-289,共4页Anatomy and Clinics

摘　　要：目的：探讨复杂性髋臼骨折手术治疗的临床疗效.方法：自2001年5月至2008年11月对63例复杂性髋臼骨折采用开放复位、重建钢板和拉力螺钉内固定手术治疗.按照Letournel分类,前柱加前壁骨折28例,后柱加后壁骨折8例,双柱骨折23例,横形加后壁骨折4例.髂腹股沟入路38例,Kocher-Langenbeck（K-L）入路12例,髂腹股沟入路联合K-L入路13例.伤后至手术时间1周内10例,1～2周27例,2～3周19例,3周以上7例.术后早期功能锻炼.结果：术后随访1～8 a,平均5.5 a,按matta评定标准,临床优良率为78%,可为14%,差8%.术后X线片示解剖复位46例（73%）,满意复位14例（22%）,不满意复位3例（5%,均为陈旧性骨折）.术中坐骨神经牵拉伤1例（另有3例术前损伤）、股神经牵拉伤1例,术后3个月均完全恢复.异位骨化伴股骨头再脱位1例（为K-L入路）,股骨头坏死1例,髋骨性关节炎5例,术后发生深静脉血栓1例,无切口感染病例.结论：复杂性髋臼骨折积极手术复位及内固定,中长期疗效好、能有效地防治其并发症.Objective： To investigate the clinical effect of surgical treatment for complex acetabular fractures. Methods：From May 2001 to Nov. 2008, 63 cases were treated with open reduction and internal fixa- tion by reconstructive plates and compression screws. According to the Letournel classification, there were 28 anterior column and wall fractures, 8 posterior column and wall fractures, 23 both column fractures and 4 trans- verse and posterior wall fractures. Ilio - inguinal approach was adopted in 38 cases, Kocher - Langenbeck ap- proach in 12cases, double approaches （k -L ＋ ilio -inguinal） in 13 cases. From injury to operation, 10 cases were within 1 week, 27 cases were 1 -2 weeks, 19 cases were 2 -3 weeks, and 7 cases were more than 3 weeks . Early function exercise was applied in all the patients. Results： According to criteria of Matta radio- graphic grade , there were 46 cases （73%）with anatomic reduction, 14 cases （22%） with satisfactory reduc- tion,3 cases （5%） with poor reduction which were all obsolete ones . The average duration of the follow -up was 5.5 years （1 -8years）. The excellent and good rate of clinical results was 78% , fair was 14% , and poor was 8%. The average operation time of ilio - inguinal approach was 2.1 hours and the average volume of hemor- rhage was 650ml ,1.7hours of K -L approach with 450ml hemorrhage. Complications included nerve injury in two cases which recovered function after 3 months, heterotopic ossification and re - dislocation of the femoral head in one, necrosis of the femoral head in one, ortho - arthritis of hip in one, DVT in one . No patients had wound infection. Conclusions：Complex acetabular fractures should be timely performed operative reduction and internal fixation, which can attain mid - term and long - term satisfactory clinical resuhs and effectively prevent the relative complications.

关 键 词：髋臼 骨折 内固定 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]