延迟手术修复陈旧粉碎性髋臼骨折24例  

Delayed surgical repair of obsolete acetabular comminuted fractures： a report of 24 cases

作　　者：康锦[1] 刘晓伟[2] 马成利[1] 高杰[1] 张绪斌[1] 张全顺[1] 

机构地区：[1]解放军第二五一医院骨关节科,张家口075000 [2]解放军第二五一医院骨二科,张家口075000

出　　处：《中华创伤杂志》2013年第10期970-974,共5页Chinese Journal of Trauma

摘　　要：目的探讨手术治疗陈旧粉碎性髋臼骨折的适应证、手术技术及疗效。方法回顾性总结2003年10月-2010年6月因合并其他脏器损伤而延期治疗的陈旧髋臼骨折24例（24髋），男18例，女6例；年龄22～68岁[（42．2±10．5）岁]。受伤至手术时间3～6周[（4．6±1．3）周]。按Letournel分型：简单骨折11例，其中后壁6例，前壁1例，后柱1例，前柱1例，横行2例；复合骨折13例，其中后柱伴后壁6例，横行伴后壁2例，“T”形骨折1例，伴后方半横行骨折2例，双柱2例。手术入路选择髂腹股沟入路2例，髋臼后侧入路13例，联合入路9例。结果24例均获得随访，时间10-36个月[（15．6±10．5）个月]。依据Matta复位标准：解剖复位21例，不满意2例，差I例。依据改良d’Aubigne-Postel临床结果评分：优21例，良2例，差1例。术后发生股骨头坏死1例，异位骨化11例，坐骨神经一过性麻痹6例。结论延迟切开复位内固定手术治疗陈旧粉碎性髋臼骨折可取得满意疗效。Objective To investigate the indications, techniques and effects in surgical treat- ment of stale acetabular comminuted fractures. Methods A retrospective review was made on 24 cases （24 hips） of obsolete acetabular fractures undergone delayed reconstruction due to the combined injuries in other organs from October 2003 to June 2010. There were 18 males and 6 females, at 22-68 years of age E mean （42.2 ± 10.5 ）years ]. Mean time from injury to operation was （4.6 ±1.3 ） weeks （range, 36 weeks）. According to Letournel classification, there were 11 simple fractures including six posterior wall fractures, one anterior wall fracture, one posterior column fracture, one anterior wall fracture and two transverse fractures and 13 compound fractures including six posterior column with posterior wall fractures, two transverse with posterior wall fractures, one T-shape fracture, two posterior semitransverse fractures and two both-column fractures. Surgery was performed via ilioinguinal approach in two cases, posterior acetabular approach in 13 and the combined approaches in nine. Results All 24 cases were avail- able to average （ 15.6 ± 10.5 ） months of follow-up （ range, 10-36 months）. Quality of reduction based on Matta standard was anatomic in 21 cases, unsatisfactory in two and poor in one. Clinical results evaluated using modified d＇ Aubigne-Postel score were excellent in 21 cases, good in two and poor in one. There were one femoral head necrosis, 11 heterotopic ossification and six sciatic nerve transient palsy after operation. Conclusion Delayed open reduction and internal fixation is effective in treatment of obsolete acetabular comminuted fractures.

关 键 词：髋臼 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]