手术治疗C型髋臼骨折的研究分析  

Surgical Treatment for Type C Acetabulum Fracture

作　　者：纪少军[1] 康锦[1] 高杰[1] 

机构地区：[1]中国人民解放军第251医院,河北张家口075000

出　　处：《河北医学》2014年第9期1438-1440,共3页Hebei Medicine

基　　金：河北省科学技术成果项目;(编号:20122589)

摘　　要：目的:探讨C型髋臼骨折严重粉碎骨软骨关节面的手术重建方法、可行性及疗效分析。方法:回顾总结2009年10月至2011年6月手术治疗严重髋臼粉碎性骨折23例23髋(AO分型均为C型),均为C型髋臼骨折;选择髂腹股沟及髋臼后侧(Kocher-langebeck)联合入路。术中先纠正稳定且累及范围较广的髋臼周边部位骨折块,基本使头臼关系恢复,再采用可吸收螺钉、植骨、骨软骨折块镶嵌挤压等重建粉碎严重的髋臼关节面(碎裂软骨下骨及未游离的关节软骨),后用骨盆重建接骨板整体固定髋臼骨折部。术后根据稳定程度酌情给予矫形鞋或皮牵引制动4-6周,后床上进行静力肌肉舒缩功能锻炼及关节被动功能锻炼,术后3月渐进下地活动。结果:随访12个月至36月,平均16.6月。对位质量采用Matta标准:解剖复位21髋,不满意1髋,差1髋。临床结果评分依照改良Mered,Aubigne-Postel(3):优21髋,良1髋,差1髋。术后股骨头坏死率(5.3%),异位骨化率(46.8%)。结论:首先通过复位髋关节外骨盆骨折及复位髋关节对位关系,其次借助可吸收螺钉、植骨、骨软骨折块间的镶嵌挤压等方法可完成C型髋臼骨折的重建,术后达到满意关节功能。Objective：To study the surgery feasibility and curative effect of articular cartilage recon-struction in severe type C crushed fracture at acetabulum .Method： A retrospective analysis was conducted from the data of 23 cases operated for severe acetabulum comminuted fracture from October 2009 to June 2011, AO classification showed Type C fractures in all the 20 males and 3 females.Koaher-langenbeck and ilioinguinal approaches were adopted .A wide range of stable area surrounding the acetabulum fracture were removed at first , to recover the relationshipof head mortar positions .Absorbable screw fracture , bone graft , cartilages folded with bones were adopted to rebuild acetabulum joint surface , which was shattered seriously （ subchondral bone and free articular cartilage ） , pelvic bone reconstruction plate was used for fixation the whole acetabulum fractures .According to postoperative stability degree , orthopedic shoes or skin traction were applied for 4 to 6 weeks, followed by diastolic exercise of static muscles and passive joints activities ex-ercise in bed for 3 months, until advanced gradually .Result： The followed up lasted for 12 to 36 months, with an average of 16.6 months.Para quality using Matta standard showed 21 anatomical reduction , better in 1 case, and poor outcome with 1 case.Clinical outcome scores using improved Mered , Aubigne-Postel, （3） showed 21 cases recovered , mild score with 1 case and low score with 1 case , postoperative femoral head necrosis rate （5.3%）, and heterotopic ossification rate （46.8%）.Conclusion：Resetting hip pelvic fractures and hip para relationship , followed by using absorbable screws , soft bone graft , and interfolding with bones and cartilages can completely reconstruct type C of acetabulum fracture , achieving satisfactory joint function after surgery .

关 键 词：髋关节 内固定 手术 栓桩 重建 

分 类 号：R687.3[医药卫生—骨科学]