完善髋臼骨折Letournel分型的探索研究  

An exploratory study to perfect the Letournel classification of acetabular fractures

作　　者：钟承桔 王钢[1] 杨运平[1] 曹生鲁 钟子毅 童凯[1] 林诗源 Zhong Chengjie;Wang Gang;Yang Yunping;Cao Shenglu;Zhong Ziyi;Tong Kai;Lin Shiyuan(Department of Orthopaedics and Traumatology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华骨科杂志》2019年第5期271-277,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81272008).

摘　　要：目的提出改良的髋臼骨折Letournel分型并评价其对临床工作的指导作用。方法回顾性分析2006年1月至2018年8月收治的170例(178侧)髋臼骨折,男129例,女41例;年龄14~82岁,平均(40.2±14.2)岁。骨折类型按照Letournel分型,借助X线片、平扫及三维CT找出不能分型的(不典型)骨折,分析并归纳出不能分型的原因。以解剖标志为基础,在3D打印骨盆模型上定义髋臼壁的明确边界。每个柱的解剖学共性是一个三面体,壁的骨折累及柱的两个面,而柱的骨折累及柱的3个面,以此来区分壁的骨折和柱的骨折。此外,柱的骨折合并壁的骨折时,用小写字母a、p、q分别代表相应的前壁、后壁、四边体的粉碎;柱的骨折未合并壁的骨折时,用数字0代表。最后,根据改良的Letournel分型对骨折进行分型,并分析骨折类型与手术入路的关系。结果 92侧(51.7%,92/178)髋臼骨折不能按Letournel分型来划分。不全性骨折(49侧,53.3%)、粉碎性骨折(28侧,30.4%)、不全性+粉碎性骨折(15侧,16.3%)是不能分型的原因。改良的Letournel分型有8种类型,包括后壁骨折、后柱骨折、前壁骨折、前柱骨折、横形骨折、"T"形骨折、前柱+后半横形骨折、双柱骨折。后柱+后壁骨折、横形+后壁骨折分别变成了后柱骨折、横形骨折的一种形式。根据改良的Letournel分型对178侧骨折重新分型,分型率为100%,显著高于原Letournel分型的48.3%(86/178),两者比较差异有统计学意义(χ2=124.06,P<0.001)。100%的后壁骨折和80.00%的后柱骨折采用后入路治疗。100%的前柱骨折和73.68%的双柱骨折采用前入路治疗。结论改良的Letournel分型可以归类所有的髋臼骨折。髋臼壁粉碎的定位在一定程度上反映了损伤的严重程度,能够更好地帮助骨科医生理解髋臼骨折的形态学和选择合适的手术入路。Objectives To put forward the modified Letournel classification of acetabular fractures, and evaluate the guiding role of the modified Letournel classification in clinical work. Methods A retrospective study of 170 patients (178 sides) with acetabular fractures treated at Nanfang Hospital between January 2006 and August 2018 was performed. Among them 129 cases were males and 41 were females. The average age was 40.2±14.2 years (range, 14-82 years). According to the Letournel classification, unclassifiable/atypical acetabular fractures were found out with plain X-ray and plain CT scan and three-dimensional CT, and then their unclassifiable reasons were analyzed. Based on anatomical landmarks, clear boundaries of acetabular walls were defined on the 3D printed pelvic model. The structure of each column is a trihedron. The wall’s fracture and column’s fracture were distinguished using a theory that the wall’s fracture involved two surfaces of column with interruption of continuity and column’s fracture involved three. When column’s fracture associated with wall’s fracture, lowercase a, p and q were used representing comminuted areas of corresponding anterior and posterior wall, quadrilateral plate respectively. When column’s fracture didn’t associates with wall’s fracture, it is marked with number 0. Finally, all fractures were classified according to the modified Letournel classification. The relationship between fracture type and surgical approach was analyzed. Results There was 51.7%(92 sides) of acetabular fractures that couldn’t be classified by the Letournel classification. Incomplete fracture lines (49 sides, 53.3%), comminuted fractures (28 sides, 30.4%), both of them (15 sides, 16.3%) were their unclassifiable reasons. There were 8 types in the modified Letournel classification, including posterior wall fracture, posterior column fracture, anterior wall fracture, anterior column fracture, transverse fracture, T-shaped fracture, anterior column+posterior hemitransverse fracture, and both

关 键 词：髋臼 骨折 分类法 

分 类 号：R687.3[医药卫生—骨科学]