50岁以上髋臼后壁骨折患者的手术疗效观察  

Surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above:a retrospective study

作　　者：孙源[1] 唐明杰[1] 孙玉强[1] Sun Yuan;Tang Mingjie;Sun Yuqiang(Department of Orthopaedics,The Sixth People's Hospital of Shanghai,School of Medicine,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《中华创伤骨科杂志》2024年第3期202-208,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨50岁以上髋臼后壁骨折患者的手术疗效。方法回顾性分析2003年8月至2021年11月期间上海交通大学医学院附属第六人民医院骨科采用Kocher-Langenbeck入路手术治疗且获得完整随访的67例50岁以上髋臼后壁骨折患者资料。男54例,女13例;年龄59.0(54.0,63.0)岁;受伤至手术时间为8.0(5.0,13.0) d。63例患者一期行切开复位内固定术,4例患者一期行髋关节置换术。记录患者的手术时间、术中出血量、术后骨折复位质量、末次随访时髋关节功能及随访期间并发症的发生情况等。结果 67例患者的手术时间为90.0(67.5,101.3) min,术中出血量为350.0(300.0,450.0) mL。63例内固定治疗患者术后骨折复位质量根据Matta评分标准评定:均达到解剖复位。67例患者术后获(112.8±62.4)个月随访。末次随访时63例内固定治疗患者根据改良Merle d’’Aubigné & Postel评分系统评定患髋功能:优56例,良3例,可2例,差2例,优良率为93.6%(59/63);4例一期行髋关节置换术患者假体均生存,髋关节Harris评分分别为94、92、91、93分。术后并发症:异位骨化15例(23.8%,15/63);坐骨神经一过性麻痹1例(1.6%,1/63);股骨头缺血性坏死并创伤性关节炎2例(3.2%,2/63),术后3年行全髋关节置换术治疗。随访期间无一例患者发生感染。结论切开复位内固定仍是50岁以上髋臼后壁骨折患者的主要治疗手段,可取得良好的临床疗效,手术治疗有助于患者关节功能和生活质量的早期恢复。Objective To investigate the surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above.Methods A retrospective study was conducted to analyze the clinical data of 67 patients with acetabular posterior wall fracture who had been treated through the Kocher-Langenbeck approach and fully followed up from August 2003 to November 2021.There were 54 males and 13 females,aged 59.0(54.0,63.0)years.The time from injury to surgery was 8.0(5.0,13.0)days.Open reduction and internal fixation was performed for 63 cases and hip arthroplasty for 4 cases by one stage.The operation time,intraoperative bleeding,quality of postoperative fracture reduction,recovery of hip function at the last follow-up,and incidence of complications during the follow-up period were recorded.Results The operation time for the 67 patients was 90.0(67.5,101.3)min,and the intraoperative bleeding 350.0(300.0,450.0)mL.According to the Matta criteria,63 patients with internal fixation achieved anatomical reduction.All the 67 patients were followed up for(112.8±62.4)months.According to the modified Merle d'Aubigné&Postel scoring system,the function of the affected hip was assessed at the last follow-up in the 63 patients with internal fixation as excellent in 56 cases,as good in 3 cases,as fair in 2 cases,and as poor in 2 cases,giving an excellent and good rate of 93.6%(59/63).The prostheses survived in all the 4 patients who underwent one-stage hip replacement,with hip Harris scores of 94,92,91,and 93,respectively.Complications included 15 cases(23.8%,15/63)of heterotopic ossification and 1 case(1.6%,1/63)of transient sciatic nerve palsy.Femoral head ischemic necrosis and traumatic arthritis occurred in 2 patients(3.2%,2/63)who had to receive total hip arthroplasty 3 years after surgery.Conclusion Open reduction and internal fixation is still the main treatment method for acetabular posterior wall fractures in patients aged 50 and above,because it can achieve good clinical outcomes and help the patients recover joint function a

关 键 词：髋臼 骨折 骨折固定术 内 治疗结果 切开复位 后壁 50岁 

分 类 号：R687.3[医药卫生—骨科学]