复杂髋臼骨折手术治疗的临床疗效及手术时机分析的病例对照研究  

Case-control study on therapeutic effects of surgery for the treatment of complex acetabular fractures and effect of waiting time for surgery on clinical results

作　　者：吕超亮[1] 方跃[1] 杨天府[1] 王光林[1] 刘雷[1] 张晖[1] 

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《中国骨伤》2011年第8期629-633,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:回顾性研究复杂髋臼骨折的手术疗效及术前等待时间对疗效的影响。方法:自2006年1月至2008年12月,采用切开复位重建钢板螺钉治疗33例复杂髋臼骨折。男28例,女5例;年龄27～57岁,平均42岁。根据术前等待时间将患者分为2组:术前等待时间大于14d组,术前等待时间小于14d组。所有患者行手术切开复位重建钢板内固定术。对患者术后进行影像学复位质量评价,根据改良的Merled’Aubigne和Postel评分标准及SF-36简便型健康调查问卷(SF-36)对患者的髋关节功能和生活质量进行评估。结果:全部患者获随访,平均时间24个月(14～47个月),骨折均愈合。手术时间平均3.5h(1.5～6.5h)。术中出血量平均1330ml(300～2500ml),其中自体血回输25例。术后骨折复位情况按Matta标准评定:解剖复位28例,满意复位4例,不满意复位1例。髋关节功能按Merled’Aubigne和Postel评分标准评定:优22例,良4例,可4例,差3例。SF-36评分总分为(70.63±17.03)分。术前等待时间小于14d组与术前等待时间大于14d组相比,术后复位质量、髋关节功能及生活质量差异均有统计学意义,前者优于后者。并发医源性坐骨神经损伤2例,异位骨化6例,创伤性骨关节炎3例,股骨头坏死1例。结论:术前充分的影像学评估,选择合理的手术入路、适当的手术时机均有利于患者术后患髋功能恢复及生活质量的提高。其中术前等待时间是较容易控制的因素,减少术前等待时间可明显改善复杂髋臼骨折的预后。Objective：To discuss the operative effects and evaluate how the waiting time before surgery influence the outcome of complex acetabular fractures.Methods：From January 2006 to December 2008,33 patients,28 males and 5 females,with complex acetabular fractures were operated in our hospital.All of them were followed up for an average 24 months（ranged,14 to 47 months）.The average age was 42 years（ranged,27 to 57 years）.According to the waiting time before surgery,all patients were divided into two groups,namely preoperative waiting time of more than 14 days group and preoperative waiting time of less than 14 days group.Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta radiological systems.The modified Merle d＇Aubigne-postel hip scoring system was used for evaluating the functional outcomes.The Mos SF-36 was used to evaluate the quality of life.Results：Anatomical reduction in 28 cases,good in 4 cases,and poor in 1 case.According to the mean Merle d＇Aubigne and Postel Score,22 patients got excellent result,4 good,4 fair and 3 bad.Average score of the Mos SF-36 was（70.63±17.03）.When time was measured as a categorical variable,an anatomical reduction and an excellent or good functional outcome were more likely if surgery was performed within 14 days.Postoperative complications：iatrogenic injuries of sciatic nerve in 2 cases,heterotopic ossification in 6 cases,traumatic osteoarthritis in 3 cases,and femoral head necrosis in 1 case.Conclusion：Good image evaluation,correct approaches,appropriate time before surgery and approach,early functional rehabilitation are essential for better outcomes in the treatment of complex acetabular fractures,of which,time to surgery is a crucial and controllable prognostic factor.

关 键 词：创伤和损伤 骨折 髋臼 骨折固定术 内 手术后并发症 

分 类 号：R683.3[医药卫生—骨科学]