髋臼骨折合并髋关节前脱位的分型及治疗  

Management of acetabular fractures associated with anterior hip dislocation by a novel classification

作　　者：曹奇勇[1] 吴宏华[1] 孙旭[1] 赵春鹏[1] 吴新宝[1] Cao Qiyong;Wu Honghua;Sun Xu;Zhao Chunpeng;Wu Xinbao(Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2020年第12期1041-1047,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京市科学技术委员会"首都临床特色应用研究"专项资助课题(Z181100001718083)。

摘　　要：目的探讨髋臼骨折合并髋关节前脱位的分型及治疗方法。方法回顾性分析2005年7月至2018年3月期间北京积水潭医院创伤骨科诊治的12例髋臼骨折合并髋关节前脱位患者资料。男7例,女5例;年龄为24~80岁,平均49.6岁。参照髋关节前脱位Epstein分型及Letournel-Judet髋臼前柱骨折分型,对髋臼骨折合并髋关节前脱位归纳出一种分型系统,共分4型:A型1例,髋关节髂骨脱位,髋臼骨折线涉及髂骨翼;B型4例,髋关节髂骨脱位,髋臼骨折涉及髂前下棘;C型5例,髋关节耻骨脱位,髋臼骨折涉及整个前壁;D型2例,髋关节闭孔脱位,髋臼骨折仅涉及前角区。髋臼骨折保守治疗5例,手术内固定治疗6例,一期关节置换1例。分析各型患者骨折复位质量及功能结果。结果1例A型髋臼骨折为不典型高位前柱骨折,4例B型、3例C型、2例D型髋臼骨折为不典型前壁骨折。10例患者获平均17.2个月(3~46个月)随访,1例失访,另1例关节置换患者未纳入随访。术后根据Matta评分标准评定髋臼骨折复位质量,末次随访时根据改良Merle d'Aubigne&Postel评分系统评定患髋功能:1例A型患者手术复位差,功能结果差。1例B型患者手术复位满意,功能结果为优;保守治疗及手术复位差各1例,功能结果均为差。C型患者手术复位满意3例,功能结果满意2例,差1例(并发BrookerⅣ级异位骨化);保守治疗1例,复位及功能结果均差。2例D型患者保守治疗,髋臼骨折复位差,功能结果均满意。结论髋臼骨折合并髋关节前脱位为一特殊类型损伤,可分为4型:A、B、C型需选择恰当手术入路复位固定髋臼骨折,D型髋关节前脱位复位后可保守治疗。Objective To introduce the management of acetabular fractures associated with anterior hip dislocation by a novel classification.Methods A retrospective study was conducted of the 12 patients with acetabular fracture associated with anterior hip dislocation who had been treated at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from July 2005 to March 2018.They were 7 males and 5 females with a mean age of 49.6 years(from 24 to 80 years).On the basis of the Epstein's classification for anterior hip dislocations and the Letournel-Judet classification for anterior column fractures of the acetabulum,we developed a novel classification of acetabular fractures associated with anterior hip dislocation by 4 types.Type A(one case):iliac dislocation plus acetabular fracture involving the iliac wing;type B(4 cases):iliac dislocation plus acetabular fracture involving the area of inferior iliac spine;type C(5 cases):pubic dislocation plus acetabular fracture involving the whole anterior wall;type D(2 cases):obturator dislocation plus acetabular fracture involving the area of anterior horn.Conservative treatment was conducted for 5 patients,operative internal fixation for 6 patients and primary arthroplasty for one patient.The management,fracture reduction and functional recovery were analyzed.Results The one case of type A belonged to an atypical fracture of high anterior column while 4 cases of type B,3 cases of type C and 2 cases of type D to an atypical fracture of anterior wall.Of this series,10 cases obtained follow-up for an average time of 17.2 months(from 3 to 46 months),one was lost to follow-up and the one undergoing arthroplasty not followed up.According to the Matta's criteria for reduction and the modified Merle d'Aubigne&Postel grading for the function of affected hip at the final follow-up:the one case of type A obtained poor operative reduction and poor functional recovery;in type B,one case obtained satisfactory operative reduction and excellent functional recovery,one poor conservative reductio

关 键 词：髋臼 骨折 髋脱位 分型 治疗 

分 类 号：R687.3[医药卫生—骨科学]