有位移的复合型髋臼骨折的手术治疗

Operative Therapy of Compound Acetabular Fracture with Dispacement

目的探讨有位移的复合型髋臼骨折的手术治疗方法并评价其疗效。方法对36例复合型髋臼骨折按不同的类型不同的手术入路,分别采用重建钢板和拉力螺钉固定,按Letournal分类,后柱和后壁骨折3例,横型和后壁骨折8例,前柱和后半横型骨折1例,T型骨折10例,完全双柱骨折14例,手术入路采用Kocher-Langenbeck入路13例,髂腹股沟入路8例,联合入路15例。结果随访6～36个月,平均21个月,按照d′AubigneandEpstein标准,优25例,良7例,可2例,差2例,优良率为88.89%,感染2例,中度骨性关节炎(OA)1例,股骨头坏死1例,～异位骨化4例。结论术前完善的影像学检查,明确的骨折分类,适当的手术时机,合适的手术入路,可靠的内固定,满意的复位,以及术后早期功能锻炼,是提高复合型髋臼骨折治疗效果的关键。

Objective To discuss operative methods of displaced compound acetabular fracture. Methods 36 acetabular fractures were reviewed and classified according to Letournal classification. In these patients, there were 3 cases of posterior column and posterior wall, 8 cases of transversal and posterior wall, 1 case of anterior column and posterior hemi-transverse, 10 cases of T type, 14 cases of complete bi-column. According to various type, we adopt various operative approach and various fixation(reconstructive plates and strain screws). Kocher-Langenbeck approach 13 cases,ilioinguinal approach 8 cases, and combined anterior posterior approach 15 cases. Results Mean 21 (Range 6～36) months, according to d′Aubigne and Epstein Scoring System, we obtained 25 excellent, 7 good, 2 fair, 2 poor, the excellent and good rate was 88.89%. Infections was seen in 2 cases moderate OA in 1 case, avascular necrosis of the femoral head in 1 case, heterotopic ossification of Ⅰ～Ⅱ type in 4 cases. Conclusion Perfectly preoperative image analysis, diagnosis of fracture classification, reasonable operation time, suitable operative approach, reliable internal fixation, satisfactory reduction, and post-operation early functional rehabilitation are all the key points for a satisfactory clinical result of compound acetabular fracture treatment.