切开复位内固定治疗老年髋臼骨折的疗效分析  

Analysis of clinical outcome of open reduction and internal fixation for geriatric acetabular fractures

作　　者：丛雨轩 雷金来[1] 樊志强 王虎[1] 邓洪利 黄海[1] 王鹏飞[1] 魏星[1] 庄岩[1] CONG Yuxuan;LEI Jinlai;FAN Zhiqiang;WANG Hu;DENG Hongli;HUANG Hai;WANG Pengfei;WEI Xing;ZHUANG Yan(Department of Orthopedic Trauma,Honghui Hospital of Xi’an Jiaotong University,X’ian,Shaanxi 710054,China)

机构地区：[1]西安交通大学附属红会医院创伤病院环骨盆病区,陕西西安710054

出　　处：《中国骨与关节损伤杂志》2023年第4期337-342,共6页Chinese Journal of Bone and Joint Injury

基　　金：陕西省重点研发计划(2019SF-120);陕西省科学技术厅创新人才推进计划(2021KJXX-57)。

摘　　要：目的 分析切开复位内固定治疗老年髋臼骨折的临床疗效。方法 回顾性分析自2013-07—2021-04采用切开复位内固定手术治疗的54例老年髋臼骨折,记录术后创伤性关节炎、股骨头缺血性坏死、异位骨化、感染、下肢深静脉血栓形成、内固定失效等并发症发生情况。采用Matta标准评定术后髋臼骨折复位质量。末次随访时采用Merle d’Aubigné-Postel评分标准评定患侧髋关节功能,采用简明健康调查简表评分(SF-36)评估患者术后生活质量。结果 本组手术均顺利完成。手术时间80~510(219.54±86.39)min,术中出血量200~4 000(1 314.82±798.21)mL,术中输血量200~5 200(1 664.82±1 118.65)mL,住院时间7~49(11.69±6.02)d。随访时间平均27.8(6~73)个月。1例术中出血采用纱布填塞止血,二次手术取出纱布;1例切口发生深部感染,经清创手术后愈合;4例发生异位骨化;4例出现股外侧皮神经损伤症状;5例螺钉松动;3例术后股骨头坏死,1例出现创伤性关节炎,4例均为髋臼骨折合并髋臼顶关节面压缩;1例术后13个月死亡。术后髋臼骨折复位质量根据Matta标准评定:优29例,良10例,差15例。末次随访时Merle d’Aubigné-Postel评分:优4例,良36例,可12例,差2例,末次随访时SF-36评分为(80.41±9.60)分。结论 切开复位内固定治疗老年髋臼骨折的中期疗效良好,骨折复位质量将影响髋关节的预后。Objective To analyze the clinical outcomes of open reduction and internal fixation in the treatment of acetabular fractures in geriatric patients.Methods Fifty four geriatric acetabular fractures treated with open reduction and internal fixation from July 2013 to April 2021 were retrospectively analyzed.The complications such as traumatic arthritis,femoral head necrosis,heterotopic ossification,infection,lower limb deep vein thrombosis,and failure of internal fixation were recorded.The quality of fracture reduction was assessed using the Matta score system;the Merle d'Aubigné-Postel score was used to assess the function of the affected hip,and the SF-36 score was used to assess the quality of life at the last follow-up.Results All patients underwent surgeries successfully.The operative time was 80-510(219.54±86.39)min,the intraoperative bleeding was 200-4000(1314.82±798.21)mL,the intraoperative blood transfusion was 200-5200(1664.82±1118.65)mL,and the hospital stay was 7-49(11.69±6.02)d.The follow-up time was 27.8(6-73)months.One case of intraoperative bleeding was treated with gauze packing and the gauze was removed in a subsequent operation.One case of deep infection healed after debridement surgery.There were four cases of heterotopic ossification,four cases with symptoms of injury of nervus cutaneous femoris lateralis and five cases of screw loosening.The femoral head necrosis occurred in three cases and traumatic arthritis in one case,and all these four cases were acetabular fractures combined with articular surface compression.One case died 13 months postoperatively.The quality of the acetabular fracture reduction was according to the Matta score system:excellent in 29 cases,good in 10 cases,and poor in 15 cases.Merle d’Aubigné-Postel score at the last follow-up:excellent in 4 cases,good in 36 cases,fair in 12 cases,and poor in 2 cases,and the SF-36 score was(80.41±9.60).Conclusion The medium-term outcome of open reduction and internal fixation for the treatment of geriatric acetabular fractures is

关 键 词：老年髋臼骨折 切开复位内固定 压缩骨折 

分 类 号：R687.3[医药卫生—骨科学]