髋臼骨折的Letournel-Judet分型诊断及手术治疗

Study on the diagnosis types of Letournel-Judet and operative treatment of fractures of the acetabulum

目的探讨髋臼骨折的Letournel-Judet分型诊断及手术治疗方法。方法 45例髋臼骨折,术前经X线片及髋臼CT明确诊断,采用Letournel-Judet分型后,分别用Kocher-Langenbeck入路30例,髂腹股沟入路11例,前后联合入路4例,应用骨盆重建钢板和螺丝钉内固定。结果全部病例获得随访,平均随访时间28.4个月。骨折复位按Matta标准,解剖复位35例,滿意复位8例,不滿意复位2例。根据改良merle d’Aubigne和Postel的髋臼骨折临床结果评分标准,优14例,良20例,一般7例,差4例,优良率为75.5%。结论术前完善影像学检查,正确分型,合理的手术入路,术中尽可能解剖复位及坚强内固定是提高髋臼骨折手术疗效的关键。

Objective To explore the diagnosis types of Letournel-Judet and operative treatment of fractures of the acetabulum.Methods 45 patients with fractures of the acetabulum were definite diagnosed by X-ray and Computed tomography preoperative. According to Letournal-Judet classification,thirty cases were operated through Kocher-Langenbeck approach,11 cases ilioinguinal approach and 4 cases combined anterior and posterior approaches.All the cases were internally fixed with the pelvis reconstructive plate and screws.Results All patients were followed up and the average time were 28.4 monthes.The fracture reduction were evaluated with Matta standard and 35 cases were anatomic reduction,8 cases' s reduction were satisfied,2 cases were failing reduction.The clinical results were evaluated by the mordified Merle'Aubigne and Postel hip score standard.The results were excellent in 14 cases,good in 20 cases,fair in 7 and poor in 4. The total excellent and good rates were 75.5%.Conclusion Preoperative imaging examination,correct classification,proper surgical approach, anatomic reduction as possible as intraoperation and stable internal fixation are essential to the outcome of the operative treatment of fractures of the acetabulum.