髋臼骨折手术内固定治疗探讨

The Operative Treatment of Acetabular Fractures with Internal Fixation

目的 探讨手术内固定治疗有移位髋臼骨折的疗效。方法 回顾性总结2 1例有移位髋臼骨折手术治疗的经验,2 1例损伤严重程度评分(ISS)平均2 1.1分,根据骨折类型选用髂腹股沟入路8例,Kocher- L angenbeck入路8例,前后联合入路3例,延长的髂腹股沟入路和三射入路各1例。复位后应用骨盆重建钢板及拉力螺钉内固定。结果 2 1例经12～5 6个月平均36个月随访,发生感染2例,创伤性关节炎6例,异位骨化5例,股骨头无菌性坏死1例。复位按Matta方法评估,解剖复位6例,满意复位12例,不满意复位3例。按Matta髋关节功能评分标准评估疗效,优7例,良10例,一般3例,差1例,优良率80 .9%。结论 对有移位的髋臼骨折,应根据骨折类型采取不同手术入路,掌握手术时机、术者的经验、术中良好的复位是提高疗效的关键。

Objective To investigate the effect of operative treatment with internal fixation of displaced acetabular fractures. Methods 21 cases displaced acetabular fractures were treated operatively with open reduction and internal fixation using reconstruction plates lag screws. The mean of injury severity score(ISS)is 21.1. According to fracture types, Ilioinguinal approach was adopted in 8 cases, Kocher-Langenbeck in 8 cases, and double approachs(K-L added up ilio)in 3 cases. Extended iliofemoral approach in 1 case and triradiate approach in 1 case. Results All patients underwent average 36 months(range 12 to 56 months). Infection was observed in 2 cases, traumatic osteoarthritis in 6 cases, heterotopic ossification in 5 cases, avascular necrosis of the femoral head in 1 case. According to criteria of Matta, 6 cases were underwent anatomic reduction, 12 cases were satisfactory reduction and 3 unsatisfactory. Based on Matta′s evaluation, 7 cases achieved excellent results, 10 good, 3 fair and 1 poor. Excellent and good rate was 80.9%. Conclusion Choice for surgical approach, operation on time, surgeon′s experience, anatomical reduction are the key points for reaching a good clinical result.