髋臼骨折的手术治疗

Surgical Treatment of Acetabular Fracture

目的介绍应用不同手术入路及方法治疗髋臼骨折的经验。方法回顾性总结了2001年～2004年收治的资料完整的手术治疗髋臼骨折61例,分型按照Letournel-Judet骨折分型:髋臼后壁骨折的6例,后柱骨折的7例,前柱骨折3例,横行骨折8例,“T”形骨折6例,后壁伴后柱骨折10例,前方伴后方半横行骨折3例,双柱骨折9例,根据不同骨折类型采用重建钢板及拉力螺钉固定。结果全部患者均得以随访,平均随访15.4个月,复位情况按Judet等的方法来进行评估:解剖复位48例,满意复位9例,不满意4例。髋关节功能按Harris评分系统进行评估:优40例,良10例,可7例,差4例。结论手术治疗是髋臼骨折的有效治疗办法,手术入路的选择,复位的质量、尤其是臼顶的复位、牢固的固定及早期功能锻炼是治疗的关键。

Objective To present experience for treatment of acetabular fracture.Using different surgical approach and method.Methods Sixty-one patients with acetabular fractures hospitalized from 2001～2004 were reviewed.According to Letournel-Judet classification,there were 6 posterior wall fractures,7 posterior column fractures,3 anterior column fractures,8 transverse fractures,6 T-shaped fractures,10 posterior column fractures accompanying posterior wall fractures,3 anterior fractures accompanying posterior hemitransverse fractures and 9 both column fractures.The reconstructive plates and compression screws were used for internal fixation basing on different classification.Results All cases were followed up by an average of 15.4 months.According to Jedut criterion,48 cases were reduced anatomically,9 cases were reduced satisfactory,and 4 cases were poor.According to Harris evaluation,40 cases were excellent,10 were good,7 were fair and 4 were poor.Conclusion Surgical treatment is effective for the treatment of acetabular fracture.Beside firm fixation and early function exercise,the operation approach and reduction quality,especially the reduction of acetabular dome are the keys of successs.