髋臼后壁边缘压缩骨折伴髋关节后脱位的诊治

Marginal compression fractures of acetabular posterior wall with posterior dislocation of hip

目的探讨髋臼后壁边缘压缩骨折伴髋关节后脱位的诊断与治疗。方法2000年2月- 2005年10月,对11例涉及髋臼后壁边缘压缩骨折伴髋关节后脱位患者进行回顾性总结,所有患者的后壁边缘压缩骨折、髋关节后脱位均由CT扫描得到证实。患者均采用手术切开复位,对边缘压缩骨折进行撬起和植骨,重建钢板螺丝钉内固定术。结果所有患者获得平均5-56个月(32．4个月)随访,临床结果采用改良d'Aubigne和Postel髋关节评分标准:优4例,良4例,可2例,差1例,优良率为72．7％。1例原发坐骨神经损伤,系骨折块压挫伤,于术后2个月完全恢复。1例因术中未严格保持伸髋屈膝位导致坐骨神经牵拉伤,4个月后基本恢复。1例异位骨化,为BookerⅡ型。1例复位欠佳者出现创伤性关节炎,关节间隙变窄。结论髋臼后壁边缘骨折伴髋关节后脱位患者容易发生边缘压缩性骨折,术前CT扫描可明确诊断,术中要对边缘压缩骨折部分撬起和充分植骨,提高股骨头与髋臼解剖对应率,可取得较好疗效。

Objective To explore the diagnosis and treatment of marginal compression fractures of acetabular posterior wall with posterior dislocation of hip. Methods Eleven patients with marginal compression fractures of acetabular posterior wall and posterior dislocation of hip were retrospectively reviewed. Their conditions were all confirmed by CT scan before operation. All the patients were treated by ORIF （open reduction with internal fixation） and the compressed bones were elevated with bone grafts. All the fractures were fixed with reconstruction plating. Results The mean follow up was 32.4 months （5 to 56 months） . The results of modified d＇Aubigne and Postel score system were excellent in four patients, good in four, fair in two, and poor in one. The good to excellent rate was 72.7%. Conclusion It is likely for patients with fractures of acetabular posterior wall and posterior dislocation of hip to have marginal compression fracture which can be definitely diagnosed by CT scan preoperatively. Good results can be obtained by elevating part of the compressed marginal bone with bone grafting, because it can improve the reduction of acetabulum and femoral head.