9例髋臼骨折的手术治疗

Surgical treatment for acetabular fracture——9 case report

目的探讨髋臼后壁(或后壁加后柱)骨折的手术治疗方法。方法2001年8月～2005年12月,收治髋臼骨折患者9例,男性8例,女性1例,年龄37～56岁,平均41.7岁;按Letournel-Judet分类法,本组7例属单纯后壁骨折,2例为后壁加后柱骨折,对8例行切开复位钢板内固定术,对1例用2块重建钢板固定后壁和后柱。结果在9例患者中,1例失访,8例获随访,时间12～36个月,平均18个月,骨折均愈合。1例发生股骨头缺血性坏死。1例发生髋关节创伤性关节炎,症状轻微,保守治疗中;1例原发性坐骨神经损伤(后壁骨折加髋关节后脱位),术中探查松解,半年后恢复;1例医源性坐骨神经不完全损伤,3个月后恢复。结论经Kocher-Langenbeck入路,切开复位,用重建钢板内固定,是治疗髋臼后壁(或后壁加后柱)骨折的有效方法。

Objective To investigate the surgical treatment for the fracture of posterior wall of acetabulum. Methods 9 patients with the acetabular fractures were treated. The range of age is 37 to 56years old and the mean age is 41.7years old. According to Letournel-Judet Classification, 7 cases were simple fracture of posterior wall of acetabulum and 2 cases were combining fractures of both posterior wall and posterior column of acetabulum. Open reduction and internal fixation with reconstructive plates were performed for these patients. Kocher-Longenbeck approach was used during the operation. Results 8 patients were followed up from 12 to 36 months and mean time is 18 months. The other 1 patient was lost follow up. All fractures were healed uneventfully. 6 patients recovered walking function 12 months postoperatively. 1 patient had severe pain on his injured hip because of the femoral head necrosis. 1 patient had mild pain on his injured hip only after long walking. There was a sign of posttraumatic arthritis in the injuried hip. 1 patient had mild iatrogenic injury of the sciatic nerve and recovered fully 3 months postoperatively. Conclusions Open reduction and internal fixation with reconstructive plate through Kocher-Longenbeck approach for the fractures of posterior wall of acetabulum is effective, safe and reliable.