前方入路切开复位内固定治疗老年髋臼骨折的疗效分析  

Open reduction and internal fixation via anterior approaches for the geriatric acetabular fractures

作　　者：曹奇勇[1] 吴宏华[1] 孙旭[1] 赵春鹏[1] 肖鸿鹄 吴新宝[1] Cao Qiyong;Wu Honghua;Sun Xu;Zhao Chunpeng;Xiao Honghu;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,北京100035

出　　处：《中华创伤骨科杂志》2023年第6期512-517,共6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：目的探讨前方入路切开复位内固定治疗老年髋臼骨折的疗效。方法回顾性分析2018年6月至2020年12月期间北京积水潭医院创伤骨科连续收治的74例髋臼骨折患者资料。根据年龄不同将患者分为两组:老年(年龄≥65岁)组16例,男8例,女8例;年龄(74.0±5.9)岁;骨折Letournel-Judet分型:双柱骨折7例,前柱骨折4例,前方伴后半横形骨折5例;受伤至手术时间(6.1±3.4)d。青壮年(年龄<65岁)组58例,男48例,女10例;年龄(46.7±10.9)岁;骨折Letournel-Judet分型:双柱骨折28例,前柱骨折14例,前方伴后半横形骨折8例,T形骨折5例,横形骨折3例;受伤至手术时间(5.4±2.7)d。所有患者均采用前方入路切开复位内固定治疗。比较两组患者的手术时间、术中出血量、骨折复位质量、手术相关主要并发症及功能结果等。结果两组患者的骨折Letournel-Judet分型、关节面压缩情况等一般资料比较差异均无统计学意义(P>0.05),具有可比性。老年组患者的术中出血量[(715.6±285.0)mL]显著少于青壮年组患者[(1008.6±463.9)mL],差异有统计学意义(P<0.05)。老年组和青壮年组患者的手术时间分别为(167.2±44.3)、(172.9±56.6)min,手术相关主要并发症分别有3、6例,术后骨折复位质量优良率分别为87.5%(14/16)、84.5%(49/58),随访时间分别为(26.6±10.7)、(23.6±10.1)个月,差异均无统计学意义(P>0.05)。末次随访时根据改良Merle d'Aubigné&Postel评分系统评定患髋功能:老年组优5例,良10例,可1例;青壮年组优21例,良33例,可2例(另2例失访),差异无统计学意义(P>0.05)。结论前方入路切开复位内固定治疗老年髋臼骨折可以取得与青壮年患者类似的疗效,是一种安全、有效的方法。Objective To evaluate open reduction and internal fixation via the anterior approaches in the treatment of geriatric acetabular fractures.Methods Retrospectively analyzed were the clinical data of 74 consecutive patients with acetabular fracture who had been treated by open reduction and internal fixation via the anterior approaches from June 2018 to December 2020.The patients were divided into 2 groups.In the geriatric group(≥65 years old):16 patients[8 males and 8 females with an age of(74.0±5.9)years];7 both column fractures,4 anterior column fractures,and 5 anterior column plus posterior hemi-transverse fractures according to the Letournel-Judet classification;time from injury to operation:(6.1±3.4)d.In the young group(<65 years old):58 patients[48 males and 10 females with an age of(46.7±10.9)years];28 both column fractures,14 anterior column fractures,8 anterior column plus posterior hemi-transverse fractures,5 T type fractures and 3 transverse fractures;time from injury to operation:(5.4±2.7)d.The 2 groups were compared in terms of operation time,intraoperative blood loss,postoperative reduction,operative complications,and functional results.Results The 2 groups were comparable because there was no significant difference in the preoperative general data like fracture Letournel-Judet classification or dome impaction between them(P>0.05).The intraoperative blood loss in the geriatric group was(715.6±285.0)mL,significantly less than that in the young group[(1,008.6±463.9)mL](P<0.05).In the geriatric and young groups,respectively,the operation time was(167.2±44.3)min and(172.9±56.6)min,3 and 6 cases had main operative complications,the good to excellent rate of postoperative reduction was 87.5%(14/16)and 84.5%(49/58),and the follow-up time was(26.6±10.7)months and(23.6±10.1)months,all showing no significant difference(P>0.05).According to the improved Merle d'Aubigné&Postel scoring system,the hip function at the last follow-up was evaluated as excellent in 5 cases,as good in 10 cases,and as fair i

关 键 词：髋臼 骨折 骨折固定术 内 切开复位 老年人 

分 类 号：R687.3[医药卫生—骨科学]