C型骨盆骨折合并髋关节中心性脱位的手术治疗

Surgical treatment of pelvic fracture of Type C combined with central dislocation of hip

目的:研究C型骨盆骨折合并髋关节中心性脱位的临床疗效。方法:13例患者中男8例,女5例;年龄23～65岁,平均36.5岁。骨盆骨折分型:C1型8例,C2型3例,C3型2例。髋臼“T”形骨折2例,粉碎性骨折9例,双柱骨折2例。均采用手术治疗,术前术后均采用股骨髁上牵引,术中采用髂腹股沟入路,必要时附加患髋后外侧切口,术中采用重建钢板固定。结果:本组随访时间6～28个月,平均13.4个月。髋臼骨折复位后残存移位:0～1mm9例,2～3mm2例,4～5mm2例,无>5mm者。髂骨骨折复位后各向残存移位:0～1mm9例,2～5mm3例,>5mm1例。3例原发性坐骨神经损伤的患者,术后3个月内其感觉、运动功能全部获得恢复。1例继发性坐骨神经损伤,术后6个月恢复。异位骨化2例,股骨头坏死、髋臼及股骨头软骨坏死、髋关节创伤性关节炎5例,患者关节疼痛、活动受限,影响功能。疗效综合评定:优8例,良1例,可2例,差2例。结论:C型骨盆骨折合并髋关节中心性脱位通过手术治疗,能够最大程度恢复其解剖结构,术后关节功能恢复较好。

Objective： To study the therapeutic effects of operative treatment for pelvic fracture of Type C combined with central dislocation of hip. Methods： Thirteen patients （ 8 male and 5 female, ranging in age from 23 to 65 years, with an average of 36.5 years）were treated with operation. According to pelvic fracture classification,8 patients were Type C1,3 patients were Type C2 ,and 2 patients were Type C3. T shape fracture of acetabulum occurred in 2 patients, comminuted fracture occurred in 9 patients, and anterior and posterior double column fracture occurred in 2 patients. The patients were treated with bone traction through supracondyle of femur before operation. Ilio-inguinal approach was used in combination with Kocher-langenbeck incision if necessary, and resconstructive plate fixation was performed during the operation. Results：All the patients were followed up from 6 to 28 months,with an average of 13.4 months. Mterr reduction, the residual displacement （RD） of acetabulum was 0 - 1 mm in 9 patients,2 - 3 mm in 2 patients ,and 4 - 5 mm in 2 patients ,without any one whose RD was more than 5 mm. The RD of ilium was 0 - 1 mm in 9 patients,2 - 5 mm in 3 patients, more than 5 mm in 1 paitent. Three patients with primary sciatic nerve injuries had complete recovery of sensation and motor function within 3 months after operation. One patient with secondary sciatic nerve injury had recovery at 6 months after operation. Two patients had heterotopic ossification, and 5 patients had ischemic necrosis of femoral head and traumatic arthritis and they still suffered from articular pain and limited movement and function. According to clinical evaluation standard,8 patients obtained excellent results, 1 good,2 fair, and 2 poor. Conclusion： The anatomic structure and function could be reconstructed with operation for the pelvic fracture of Type C combined with central dislocation of hip.