髋臼后壁骨折伴髋关节后脱位诊疗失误及并发症分析  

Analysis of diagnostic and therapeutic error and complications in acetabular posterior wall fractures combined with hip joint dislocation

作　　者：周炎 瞿新丛 易成腊[2] 代磊[3] 方祖怡 刘祥 潘晓辉 丰峰 

机构地区：[1]罗田县人民医院骨科,湖北438600 [2]华中科技大学同济医学院附属同济医院创伤中心,湖北武汉430030 [3]黄梅县中医院骨科,湖北435500

出　　处：《创伤外科杂志》2013年第3期216-219,共4页Journal of Traumatic Surgery

摘　　要：目的探讨髋臼后壁骨折伴髋关节后脱位诊疗过程中失误原因及与术后早、中期并发症的关系。方法 2006年1月～2009年6月收治的55例髋臼后壁骨折伴髋关节后脱位患者。髋臼后壁骨折按Letournel分类,典型后壁骨折30例,后上骨折15例,后下骨折10例。受伤至就诊时间平均为8h(0.5～14h),至手术内固定时间平均为7d(3～11d)。回顾诊疗经过,并对术后早、中期并发症进行分析。结果 55例随访28～36个月(平均32个月)。1例合并胫骨近端骨折患者髋关节闭合整复过程中发生腘血管损伤;8例于内固定术前CT检查发现股骨头仍处于后脱位状态,术后12～25个月(平均16.5个月)均出现股骨头囊性变;12例出现髋关节异位骨化。依据Matta髋臼骨折复位标准,优32例,良19例,可3例,差1例;优良率92.7%。按Matta改良的Merle d’Aubigne和Postel髋关节功能评分系统评价,优25例,良17例,可8例,差5例;优良率为76.4%。结论术前髋关节漏诊、骨牵引体位不当以及闭合整复操作中对股骨头复位误判是诊疗失误的主要原因。延迟复位增加了术后早中期股骨头缺血性改变及异位骨化发生率。Objective To investigate the causes of diagnostic and therapeutic error in acetabular posterior wall fractures combined with hip joint dislocation, and analyze the complications in the early and median stage after operation. Methods From Jan. 2006 to Jun. 2009, 55 patients suffered acetabular posterior wall fractures com- bined with dislocation were identified. According to the Letournel classification, there were 30 cases of typical poste- rior wall fracture, 15 cases of postero-superior wall fracture and 10 cases of postero - inferior wall fracture. The aver- age time from injury to hospitalization was 8 hours （range,0. 5-14 hours） ,and the average internal fixation time was 7 days （ range, 3 - 11 days）. According to the diagnostic and therapeutic process, the complications after operation in early and median stages were analyzed. Results The mean follow-up time of all patients was 32 months （ range, 28-36 months）. One case of proximal tibia fracture got popliteal vascular injury during the closed reduction of the hip. Eight cases were found posterior dislocation of the femoral head confirmed by CT scan before operation, who occurred femoral head cystic degeneration by the mean follow-up of 16. 5 months （range, 12-25 months）. Twelve cases got hip heterotopic ossification. The quality of reduction was excellent as anatomical in 32 patients, good in 19, fair in 3,poor in 1 by M atta＇ s score system, and the good to excellent rate was 92. 7%. According to the modi- fied Merled＇ Aubigne and Postel score system,25 cases were excellent, 17 cases good,8 cases fair,5 cases poor, and the good to excellent rate was 76.4%. Conclusion Preoperative mis-diagnosis of hip,improper bone traction pos- tures before operation and misjudgement on the femoral head reset in the closed reduction are the main causes of di- agnostic and therapeutic error. Delayed reset increases the rate of avascular change and heterotopic ossification in early and median stage after operation.

关 键 词：髋臼骨折 髋关节 脱位 内固定 并发症 

分 类 号：R683[医药卫生—骨科学]