移位髋臼骨折手术治疗结果的分析

Analysis on Operative Treatment Effectiveness of Displaced Acetabular Fractures

目的 探讨髋臼骨折的治疗方法。方法 回顾性分析 1990年 1月至 2 0 0 2年 5月收治的手术治疗 15 6例移位髋臼骨折的临床和 X线特征。130例作为研究对象。按 Judel和 L etournel的髋臼骨折分类标准 ,其中简单骨折 36例 ,复杂骨折 94例。单发伤 5 2例 ,多发伤 78例。手术时间为伤后 2 1d以内 ,平均 8.2 d。年龄 13～ 89岁 ,平均 4 6 .5岁。130例均获得随访 ,平均随访 1.5 a。结果 按 Matta的复位标准 ,130例中 ,解剖复位 87例 (6 7% ) ,满意 2 7例 (2 1% ) ,不满意 12例 (9% )。髋臼双柱骨折“二次匹配”是 4例 (3% )。复位质量随年龄增加而不理想。根据 HHS(Harris hip score)评分 ,优5 4例 (42 % ) ,良 39例 (30 % ) ,可 17例 (13% ) ,差 2 0例 (15 % )。87例解剖复位患者中有 76例 (89% )临床结果优良 ,37例可差患者中有 2 8例 (77% )为多发性损伤。结论 解剖复位的髋臼骨折预后较好 ,特别是年轻患者 ,运用移位髋臼骨折手术治疗更具优越性。

Objective To disscuss the therapeutic management of the displaced acetabualar fractures. Methods This study examined retrospectively the clinical and radiographic features of 156 patients with displaced acetabular fractures. 130 patients met the inclusion criteria. According to Judet and Letournel′s classification of acetabular fractures: 36 simple and 94 complicated fractures. Multiple trauma was found in 78 cases. The mean time from the injury to surgery was 8.2 days (range, 0～21 days). The mean age of the patients was 46.5 years (range,13～89 years). 130 cases were followed-up for an average of 1.5 years. Results According to Matta′s reduction criteria: anatomic in 87(67%),imperfect in 27(21%), poor in 11(9%), and secondarily congruent in 3 both-column fractures (3%). The quality of the reductions markedly deferiorated with advancing age. According to Harris hip score: excellent in 54(42%), good in 39(30%),fair in 17(13%), and poor in 20(15%). Excellent and good clinical result were recorded in 76(89%) of 87 patients with an anatomic reduction.Of the 37 patients with fair and poor results, 28 patients(77%) had complicating factors recognizable at clinical presentation, including articular abrasion,a femoral head of neck fracture and so on. Conclusion Stable anatomic reduction of most displaced acetabular fractures offered the optimal prognosis, especially in younger patients, A reappraisal for the role of the current therapeutic alternatives of nonoperative treatment, a limited open reduction, or an total hip replacement merits was reviewed.