髋臼骨折合并严重多发伤的手术治疗策略  

Treatment strategy for severe multiple trauma patients with acetabular fractures

作　　者：安志刚[1] 李力更[1] 郑煦光[1] 陈杰[1] 王宏伟[1] 

机构地区：[1]唐山市第二医院ICU科,河北063000

出　　处：《中国骨与关节损伤杂志》2015年第10期1009-1012,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 探讨髋臼骨折合并严重多发伤的手术治疗方法及术后疗效。方法 回顾性分析自2005-01—2013-03诊治合并严重多发伤的髋臼骨折78例,抢救无效死亡2例,出现休克63例,肺栓塞6例,脂肪栓塞12例,急性呼吸窘迫综合征（ARDS）16例。76例髋臼骨折行切开复位内固定术,前侧入路8例,后侧入路27例,前后联合入路41例,均采用髋臼重建钢板固定,部分结合拉力螺钉、克氏针固定。结果 76例髋臼骨折手术时间126-358 min,平均165 min;术中出血量800-3 500 ml,平均1 200 ml。髋臼骨折复位质量按Matta提出的标准评定：解剖复位47例,满意复位18例,一般复位7例,复位差4例,复位满意率85.5%。本组69例获得随访,随访时间14-113个月,平均57.6个月。临床效果采用改良Merled Aubigne-Postel评分系统评定：优40例,良19例,可6例,差4例,优良率85.5%。17例髋臼骨折术后出现表浅切口裂开,脂肪液化坏死;1例后路深部感染;原发性坐骨神经损伤15例,医源性神经损伤2例;23例发生异位骨化;2例股骨头坏死。结论 髋臼骨折合并严重多发伤患者病情危重,治疗复杂,要在抢救生命的同时适度兼顾髋臼骨折的处理,待病情平稳后灵活选择多种方式分阶段综合治疗。Objective To investigate the effect of treatment methods of acetabular fractures in patients with severe multiple trauma.Methods Seventy-eight cases of acetabular fractures with severe multiple injuries were retrospectively analyzed from January 2005 to March 2013.Two cases were dead,63 cases of shock,6 cases of pulmonary embolism,12 cases of fat embolism,16 cases of acute respiratory distress syndrome（ARDS）.Seventy six cases of acetabular fractures were treated by open reduction and internal fixation,with anterior approach in 8 cases,posterior approach in 27 cases and combined anterior and posterior approach in 41 cases.All were treated with acetabular reconstruction plate fixation,cannulated screws and Kirschner wire fixation.Results Operation time of seventy-six cases of acetabular fracture was 126-358 min,an average of165 min; intraoperative blood loss 800-3 500 ml,an average of 1 200 ml.According to the standard of Matta,47 cases were anatomic reduction,18 cases were satisfactory,7 cases were mediocre,4 cases were poor,the satisfactory rate was 85.5%.Sixty-nine cases were followed up for 14-113 months,and the average was 57.6 months.The clinical effect was evaluated by modified Aubigne-Postel Merled scoring system：40 cases were excellent,19 cases good,6 cases acceptable,4 cases poor,the excellent and good rate was 85.5%.Seventeen cases of acetabular fractures appeared superficial incision split and fat liquefaction necrosis.There was one case of deep posterior approach infection.Primary sciatic nerve injury occurred in 15 cases,there were 2 cases of iatrogenic nerve injury,23 cases of heterotopic ossification and 2 cases of femoral head necrosis.Conclusion The treatment is complicated for the severe multiple injury patients with acetabular fractures,rescuing the life while properly dealing with the fractures,and the stage treatment of acetabular fractures should be considered when the general condition of the patients is stable.

关 键 词：髋臼骨折 严重多发伤 并发症 急诊手术 内固定 

分 类 号：R687.3[医药卫生—骨科学]