髋臼后壁骨折88例的手术治疗

Surgical treatment of acetabular posterior wall fractures in 88 cases

目的 探讨髋臼后壁骨折手术内固定的临床结果与X线平片分级、年龄以及髋关节脱位复位时间的关系。 方法 对 88例手术内固定患者进行为期 2 .0～ 7.4年的随访 ,采用Matta改良分级系统对结果进行评价。 结果 骨折复位达解剖复位者 81例 ,7例不完全复位。临床结果 :优 5 1例 ,良 18例 ,一般 8例 ,差 11例。X线平片 :优 5 9例 ,良 12例 ,一般 13例 ,差 4例。结论 临床结果不佳的危险因素包括髋脱位延迟复位 (≥ 12h) ,损伤时年龄≥ 5 0岁 ,关节内粉碎性骨折等。X线平片分级与临床结果之间呈显著正相关。髋关节脱位复位越早越好。老年人和伴有广泛粉碎性骨折者出现较差结果可能性更大。

Objective To determine the relationship of the clinical treatment results of the posterior wall fracture of the acetabulum by open reduction and internal fixation with X-ray radiography,patient age and time for dislocation and reduction. Methods A total of 88 patients treated with open reduction and internal fixation of an unilateral fracture of the posterior wall of the acetabulum were studied and followed up for 2.0-7.4 years (average 3.9 years). The clinical outcome was assessed by Matta's grading system. Results The reduction of the fracture was ranked as anatomic reduction in 81 patients and as incomplete reduction in seven. The clinical outcome was excellent in 51 patients,good in 18,fair in 8 and poor in 11. The X-ray radiography showed excellent result in 59 patients,good in 12,fair in 13 and poor in four. Conclusions The risk factors for an unsatisfactory clinical result include delayed reduction (≥12 hours) of a hip dislocation,over 50 years of age at the time of injury and intra-articular comminuted fracture. There is a strong correlation between the clinical results and the X-ray grades. The sooner is the reduction of the dislocated hip,the better is the clinical outcome. It is more possible for elderly patients over 50 years old and those with comminuted fractures to have a poor clinical result.