髋臼骨折368例治疗分析

Acetabular fractures:a report of 368 cases

目的 探讨影响髋臼骨折疗效的因素。 方法 对 1984年 1月～ 2 0 0 2年 12月经治的髋臼骨折 386例进行临床观察 ,所有患者按Letournel-Judet分类 ,就其骨折分型、患者年龄、就诊时间、伴发创伤、髋臼骨折治疗并发症、不同的手术显露和治疗方法等方面进行分析。 结果 36 8例经 8个月～ 17年、平均 4年 11个月随访 ,按Matta评定法 ,保守治疗组 2 7例 ,优 11例 (4 0 .7% ) ,良 11例 (4 0 .7% ) ,尚可 3例 (11.2 % ) ,失败 2例 (7.4 % ) ,优良率 81.4 %。手术治疗组 341例 ,优 111例 (32 .6 % ) ,良 16 9例 (4 9.6 % ) ,尚可 5 7例 (16 .7% ) ,失败 4例 (1.2 % ) ,优良率 82 .1% ,总优良率为 82 .1%。无死亡和感染。 结论 术前正确分析骨折移位和类型、选择适当的手术径路、良好的手术整复工具、适时手术 ,是提高髋臼骨折治疗效果的重要保证。

Objective To discuss the factors affecting the treatment results of acetabular fractures. Methods Clinical analysis was done on 368 cases of acetabular fractures treated from January 1984 to December 2002. Of all,27 cases were treated conservatively and 341 with operative management. All the acetabular fractures of the patients were classified according to the Letournel- Judet classification system and analyzed in respects of the acetabular fracture type,the patient age,the time for medical treatment,the associated injury,the complications of the acetabular fractures,the various surgical exposure and the special surgical treatments. The reconstruction plate,screws and other internal fixation were adopted according to different fractures. Results All 368 cases were followed up for from 8 months to 17 years (average four years and eleven months). According to Matta's evaluation system,of 27 cases treated conservatively,the treatment results were excellent in 11 (40.7%),good in 11 (40.7%) ,fair in 3 (11.2%) and poor in 2 (7.4%),with an excellence rate of 81.4%. Among 341 cases with operative treatment,111 (32.6%) were excellent,169 (49.6%) good,57(16.7%) fair but 4 (1.2%) failed,with an excellence rate of 82.1%. The total excellence rate was 82.1%. No death or infection occurred in this group. Conclusions Correct analysis of the displacement of acetabular fractures and the type of Letournel-Judet classification,reasonable surgical approach,suitable stool for fracture reduction and timely surgery are key to improvement of treatment results of the acetabular fractures.