移位髋臼横形骨折的诊断和治疗

DiagnosisandTreatmentofDisplacedTransverseFracturesoftheAcetabulum

报告１７例移位髋臼横形骨折（下称ＤＴＦＡ）的诊断和治疗，其中单纯ＤＴＦＡ１１例，合并后壁骨折６例．采用Ｍａｔｔａ顶弧角临界值划分累及臼顶（ＴＴＦ）１２例（１０例手术，２例因严重脑外伤未手术）；累及臼窝（ＩＴＦ）５例（４例骨牵引治疗，１例因合并后壁骨折手术）．随访１～５年，结果４例ＩＴＦ关节功能和Ｘ线表现均优良，手术治疗的１例ＩＴＦ和１０例ＴＴＦ优良率８２％，尚可１８％，非手术治疗的２例ＴＴＦ均为差．表明累及臼顶的ＤＴＦＡ应手术治疗，而累及臼窝者除合并后壁骨折外均可行保守治疗，还表明Ｍａｔｔａ顶弧角对于划分臼顶和臼窝区的ＤＴＦＡ，决定是否手术治疗具有重要意义．作者认为ＤＴＦＡ的诊断应将Ｘ线摄片与ＣＴ诊断相结合，手术入路应根据骨折移位方向选用前、后或双入路，复位应采用特制复位钳，固定应采用弧形髋臼骨折钢板，并避免广泛骨膜下剥离，减少异位骨化，方可获得理想疗效．

Seventeencasesofdisplacedtransversefracturesoftheacetabulum(DTFA)werereviewed.Thedi-agnosiswasestablishedaccordingtoLetournel'sclassificationandCTstandard.Thefractureswereclassifiedintotranstectumfracture(TTF,12cases)andinfratectumfracture(ITF,5cases)basedonMata'smeasurementmethod.FourofITFandtwoofTTFweretreatedconservatively,oneITFassociatedwithposteriorwalfracture(PWF)and10TTFweretreatedsurgicaly.Theaveragefolow-upwas3years.FourofITFtreatedconservative-lyhadexcelentresultbothclinicalyandradiographicaly.Eleventreatedsurgicalymadeanexcelentrateof82%,fairrateof18%.TwoofTTFtreatedconservativelyhadpoorresults.TheauthorsconcludedthatDTFAshouldbetreatedsurgicaly,whilethecasesassociatedwithPWFshouldbetreatedconservatively.TheMatta'smeasurementisimportantfordecidingwhetherornottheweight-bearingdomeisinvolvedandwhetherornotanopenreductionandinternalfixationisindicated.ThecombinedCTandconventionalradiographyisvaluabletoes-tablishthediagnosisofDTFA.Surgicalapproachesshouldbeselectedaccordingtothedisplacementofthefrac-turesandDTFAshouldbereducedwithaspecialforcepsandfixedwithcurvedacetabulumplates.Theincidenceofectopicboneformationmaybereducedbyavoidingextensivesubperiostealdissection.