常规髋臼手术入路加大转子截骨治疗复杂髋臼骨折  

Management of complicated acetabular fractures with great trochanteric osteotomy via conventional acetabular approaches

作　　者：吴宏华[1] 王满宜[1] 吴新宝[1] 朱仕文[1] 曹奇勇[1] 

机构地区：[1]北京积水潭医院（北京大学第四临床医学院）创伤骨科,100035

出　　处：《中华创伤骨科杂志》2012年第5期372-375,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨常规髋臼手术入路加大转子截骨治疗复杂髋臼骨折的疗效。方法2006年1月至2009年12月共收治13例复杂髋臼骨折患者，男10例，女3例；年龄21～52岁，平均39．3岁；骨折根据Letournel—Judet分型：双柱骨折10例，T形骨折2例，前方＋后方半横断骨折1例。受伤至手术时间为8～18d，平均12．1d。所有患者均采用常规髋臼手术入路（Kocher-Langenbeck入路或Kocher-Langenbeck加髂腹股沟联合入路）加大转子截骨治疗。术后采用改良Merle d’Aubigne和Postel评分标准评定患者疗效，同时记录患者术后并发症的发生情况。结果13例患者术后获平均26个月（14～34个月）随访。骨折复位质量：解剖复位5例，良好复位7例，不满意复位（髋臼顶存在压缩骨折）1例。大转子截骨均愈合良好。根据改良Merle d’Aubigne和Postel评分标准评定患者疗效：优4例，良5例，中4例，优良率为69．2％。3例（23．1％）患者发生异位骨化，3例（23．1％）患者发生创伤性关节炎。无感染及股骨头缺血性坏死等并发症发生。结论髋臼前方＋后方半横断骨折、T形骨折及双柱累及髋臼顶的骨折可通过在常规入路中加用大转子截骨治疗，手术显露好且有利于复位和固定，术后患者功能恢复良好。Objective To evaluate the efficacy of great trochanteric osteotomy through conventional acetabular approaches in treatment of complicated acetabular fractures. Methods From January 2006 to December 2009, 13 acetabular fractures were treated in our department. They were 10 men and 3 women, 21 to 52 years of age （average, 39.3 years）. According to Letournel-Judet classification, there were 10 cases of double column fracture, 2 cases of T-shaped fracture and one case of anterior-posterlor semi-transverse fracture. The mean time from injury to surgery was 12. 1 days （from 8 to 18 days）. They were treated with great trochanteric osteotomy through conventional acetabular approaches （Kocher-Langenbeck or Kocher-Langenbeck plus ilioinguinal approaches） . Modified Merle d＇Aubign6 and Postel evaluation system was used to assess functional recovery, and complications were recorded at the follow-up. Results All cases were followed up for an average duration of 26 months （from 14 to 34 months）. Five cases obtained anatomic reduction, 7 good reduction and one poor reduction （compression fracture at the acetabular top）. All fractures healed. Four cases were rated as excellent, 5 as good and 4 as fair, with an excellent to good rate of 69.2%. Heterotopic ossification was found in 3 cases （23.1%） and traumatic arthritis in 3 cases （23. 1% ）. Neither infection nor ischemic necrosis of the femoral head was recorded. Conclusion Complicated acetabular fractures, like T-shape, double column, anterior column plus posterior semi-transverse, and transverse plus posterior wall ones, can be treated by great trochanteric osteotomy through conventional approaches, because this surgical strategy can provide fine operative exposure which facilitates reduction and fixation.

关 键 词：髋臼 骨折 骨折固定术 内 截骨术 

分 类 号：R687.3[医药卫生—骨科学]