髋臼骨折的手术治疗

Operative Treatment of Acetabular Fractures

目的探讨髋臼骨折的诊断、手术治疗和并发症的防治.方法根据术前摄片对26例移位髋臼骨折,CT平扫和三维重建确定骨折类型和制定手术方案,选择最佳手术入路进行骨折复位,并用骨盆重建钢板固定. 结果 26例患者获得1～4年,平均2年的随访,根据Matta临床标准评定: 优14例(占55%),良8例(占30%),可4例(占15%),优良率85%. 并发症主要有坐骨神经损伤、创伤性关节炎和异位骨化. 结论手术解剖复位、坚强内固定和早期功能锻炼是移位髋臼骨折的治疗原则,而术前正确诊断骨折类型、选择最佳入路,是改善复位质量及提高疗效的关键.

OBJECTIVE To discuss the diagnosis、operation and prevention of complications of acetabular fractures. METHODS 26 cases of acetabular fractures with displacement were examined by X-ray、CT and 3D-CT before operation in order to recognize the classification of fractures and the method of operation. All the cases were fixed by metal reconstruction plates by the appropriate surgical approach. RESULTS 26 cases were followed up for 1~4 years, with an average of 2 years. According to Matta's criteria clinically, 14(55%) excellent, 8(30%)good, 4(15%) fairs. The rate of excellence and good was 85%.The major complications were sciatic never injury、 traumatic arthritis and ectopic ossifacation. CONCLUSION The principle of the treatment in displaced acetabular fracture is precise reduction、firmly internal fixation and early functional training. The key to enhance the effectiveness and improve the quality of replacement in the treatment of acetabular fracture is the recognized diagnosis of fracture and the selection of the best surgical approach.