复杂髋臼骨折的手术治疗

Surgical treatment of complex acetabular fractures

[目的] 总结移位复杂型髋臼骨折的手术治疗经验.[方法] 1998年1月～2004年2月,共手术治疗32例,其中T形骨折8例,后柱伴后壁骨折4例,横行伴后壁骨折9例,双柱骨折10例,前柱伴后半横行骨折1例.手术采用Kocher-Langenbeck(K-L)入路13例,髂腹股沟入路11例,双入路(髂腹股沟+K-L入路)8例.应用普通钢板螺钉及骨盆重建钢板螺钉进行骨折复位固定.[结果] 30例获得随访,平均随访28个月(6～79个月),根据改良的Merle d′ Aubigne和Postel的髋臼骨折临床结果评分标准:优8例,良14例,一般6例,差2例,优良率为73.3%.[结论] 移位复杂型髋臼骨折应尽早手术治疗,术前准确分析骨折类型,选择正确的手术入路,对骨折进行解剖复位,并采用有效内固定是提高手术疗效的关键.

[Objective] To Summarize the surgical experiences of complex acetabular fractures. [Methods] Thirty -two cases of complex acetabular fractures were treated with open reduction and internal fixation from January 1998 to February 2004. Of the 32 cases, T-shaped fractures were seen in 8 cases, fractures of the posterior column and wall in 4, transverse and posterior wall in 9, both column in 10, anterior and hemi-transvers in 1 case. Kocher-Langenbeck approach was adopted in 13 cases, ilio-inguinal approach in 11 cases, doudle ap- proaches (K-L+ ilio- inguinal) in 8 cases. Fractures were fixed with pelvic reconstract plates and screws. [Results] Thirty cases were followed-up for average 28 months (6~79 months). Excellent results were found in 8 cases, good in 14, fair in 6, and Poor in 2. The excellent and good rate was 73.3%. [Conclusion] Dis- placed complex acetabular fractures should be operated on time. Correct classification of fracture before opera- tion , appropriate selection of operative approach, anatomical reduction, and strong internal fixation are key points to improve outcome of complex acetabular fracture.