关节压缩成型技术治疗髋臼后壁骨折的疗效分析  

Articular compression molding techniques for acetabular posterior wall fracture

作　　者：康锦 李永乐[1] 郑铁钢[1] 刘晓伟[1] 李超[1] 薛杨[1] 贾艳辉 刘爱文 田高波 韩胜义 于涛[1] Kang Jin;Li Yongle;Zheng Tiegang;Liu Xiaowei;Li Chao;Xue Yang;Jia Yanhui;Liu Aiwen;Tian Gaobo;Han Shengyi;Yu Tao(Department of Orthopaedics,The Hospital of 81 Group Army of PLA,Zhangjiakou 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院骨科,河北省张家口市075000

出　　处：《中华创伤骨科杂志》2019年第11期995-999,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨关节压缩成型技术治疗髋臼后壁骨折的方法和疗效。方法回顾性分析2014年1月至2018年1月期间中国人民解放军陆军第八十一集团军医院骨科采用关节压缩成型技术手术治疗的28例(28髋)髋臼后壁骨折并关节面粉碎压缩患者资料。男25例,女3例;年龄26~63岁,平均49.3岁。受伤至手术时间为4~12 d,平均7.8 d。按Letournel-Judet分型全部为单一元素(简单)后壁骨折,均合并股骨头后脱位及不同程度关节压缩;一过性坐骨神经损伤12例。髋关节后脱位均急诊手法复位及时、成功复位。后壁及关节压缩骨折进行切开复位内固定手术,手术入路均选择髋臼后侧(K-L)入路。术中关节压缩部分应用4种稳定技术:可吸收螺钉固定阻挡技术10例,留置螺钉固定技术12例,留置克氏针固定技术2例,"模具顶推挤压夯实"技术4例。记录手术时间、术中失血量及并发症情况。末次随访时根据改良Merle d'Aubigne&Postel评分标准评定疗效。结果手术时间76~118 min,平均94.2 min;术中失血量100~320 mL,平均220.8 mL。无切口液化、感染等并发症发生。28例患者术后均获随访,随访时间10~36个月,平均17.6个月。术后骨折复位质量按Matta评分标准评定:解剖复位24例,不满意4例。末次随访时根据改良Merle d'Aubigne&Postel评分标准评定疗效:优26例,良2例。异位骨化3例,影像学关节腔内微小游离致密影(圆韧带内约2 mm)3例。术后无一例患者发生明显创伤性关节炎或骨性关节炎,无股骨头坏死、行走疼痛、跛行及髋外展无力等;12例患者术前合并损伤涉及坐骨神经一过性麻痹均于术后3个月内恢复。结论关节压缩骨折成型技术可有效治疗髋臼后壁骨折中严重的关节粉碎性压缩,提高关节面复位质量及髋关节匹配性、稳定性,关节功能恢复良好。Objective To evaluate the efficacy of articular compression molding techniques in the surgery for acetabular posterior wall fracture.Methods A retrospective study was conducted of the 28 patients(28 hips)with fracture of acetabular posterior wall plus comminuted compression of articular surface who had been treated using the articular compression molding techniques at Department of Orthopedics,The Hospital of 81 Group Army of PLA from January 2014 to January 2018.They were 25 males and 3 females,aged from 26 to 63 years(average,49.3 years).The time from injury to surgery ranged from 4 to 12 days(average,7.8 days).According to the Letournel-Judet classification,all were single element(simple)posterior wall fractures combined with posterior dislocation of the femoral head and articular compression of different degrees;transient sciatic nerve injury was complicated in 12 cases.The posterior hip dislocations were timely and successful reset at emergency treatment.The compression fractures of the posterior wall and hip joint were treated by open reduction and internal fixation via the acetabular posterior(K-L)approach.The articular compression was treated by 4 stabilization techniques:absorbable screwing and blocking technique in 10 cases,indwelling screwing in 12 cases,indwelling Kirschner wiring in 2 cases and die push and squeeze tamping in 4 cases.The operation time,intraoperative bleeding and complications were recorded.The therapeutic efficacy was evaluated by the modified Merle d’Aubigne&Postel scoring criteria at the final follow-up.Results The operation time lasted from 76 to 118 minutes(average,94.2 minutes);the intraoperative bleeding ranged from 100 to 320 mL(average,220.8 mL).No incision liquefaction,infection or other complications occurred.The 28 patients were followed up for 10 to 36 months(average,17.6 months).According to the Matta scoring criteria,24 cases achieved anatomical reduction but 4 dissatisfactory reduction.By the modified Merle d’Aubigne&Postel scoring criteria at the final follow-up,

关 键 词：髋臼 髋骨折 骨折固定术 内 关节压缩 复位成型 

分 类 号：R68[医药卫生—骨科学]