髋臼骨折合并髋臼关节面压缩缺损的治疗策略

Treatment of acetabular comminuted fractures associated with compressive articular surface of the acetabulum

目的探讨治疗髋臼骨折合并髋臼关节面压缩缺损的手术方法与措施。方法1997年7月至2005年2月，收治复杂性髋臼骨折合并髋臼关节面压缩缺损43例，其中复杂骨折与缺损34例，简单骨折与缺损9例。缺损体积3～9cm^3．平均4．5cm^3。采用改良髋臼入路，通过髋臼碎骨关节面整复法，自体髂骨髋臼后壁解剖性重建法重建髋臼关节面，应用髋臼三维记忆内固定系统（ATMFS）固定碎骨块，自体骨＋人工骨填塞骨缺损，骨腊隔离法预防异位骨化等相关措施。术后随访5～86个月，平均15．7个月。结果髋臼骨折关节面粉碎填补压缩体积至头臼解剖复位31例，自体髂骨后壁解剖性重建头臼解剖复位12例；40例平均5．3月伤侧髋关节功能达到健侧水平；1例股骨头缺血性坏死；2例异位骨化合并股骨头缺血性坏死导致髋关节骨性融合。结论该方法与措施有效地提高了股骨头与髋臼解剖对应率，为髋关节功能的恢复提供了新的思路。

Objective To discuss the therapy for acetabular comminuted fracture with compressive articular surface of the acetabulum. Methods From July 1997 to February 2005, 43 cases of comminuted acetabular fracture with compressive articular surface of the acetabulum were treated in our hospital, in whom 34 cases were subjected to complicated fractures and defects, 9 cases were simple fractures and defects. The defect volume was 3 -9cm^3, and averaged 4.5cm^3. All the cases were treated with ATMFS which could fixate the comminuted bone three dimensionally, the acetabular comminuted bone articular face reductive method, the anatomical reconstruction method of posterior wall of the acetabulum with auto ilium, the autogeneous and artificial bone implantation method or bone wax isolation methods. The follow-up duration was 5 N 86 months, and averaged 15. 7 months. Results In this series, 31 cases achieved anatomical reduction by filling up the compressive defects, and 12 cases were treated by anatomical reconstruction of posterior wall. The function of injured hip joints was restored to the healthy one in 40 cases for 5.3 months on average after operation. Ischemia necrosis of the femoral head was seen in one case, and heterotopic ossification with ischemia necrosis of the femoral head in two cases, which led to osseous fusion of hip joint. Conclusion The new methods employed in this series for treatment of acetabular fractures with compressive defects ameliorate the reduction rate of the acetabulum and femoral head, and offer an promising regime for the recovery of hip joint function.