髋臼骨折手术疗效影响因素分析

A study on influential factors related to surgical outcomes in acetabulum fracture

目的探讨影响髋臼骨折手术疗效的相关因素及其防治措施。方法分析1998年1月至2006年1月手术治疗的资料完整的髋臼骨折患者122例,按Letournel分类法研究骨折类型、移位程度、方向,了解合并损伤、手术时间、术后并发症、髋臼功能及手术入路的选择。按Matta提出的X线评定标准和临床评分标准进行评定。结果全部病例获得1年～8年10个月的随访,平均51.8个月。Matta X线评定:解剖复位71例,满意复位34例,不满意复位17例,复位优良率为86.1%。临床评定:3周内手术者103例,优66例,良23例,可12例,差2例,优良率86.4%;3周后手术者19例,优3例,良4例,可5例,差7例,优良率36.8%。并发异位骨化27例,创伤性关节炎19例,髋臼坏死1例,股骨头坏死3例,术后脂肪液化3例,浅表感染1例。术前3例合并坐骨神经损伤的患者中有2例有不同程度的恢复。结论髋臼骨折的复位质量是决定手术疗效的关键,但其影响因素较多。术前综合分析、把握手术时机、正确选择手术入路、避免并发症发生是提高临床疗效的保证。

Objective To investigate the influential factors related to surgical outcomes in acetabular fractures and provide suggestions on relevant precaution. Methods Full data from 122 cases of acetabular fractures treated surgically between January 1998 and January 2006 were reviewed and evaluated for types of fracture, combined injuries, operative time, postoperative complications, acetabular functions, and operative approaches according to Letournel method. The clinical functions and radiological changes were assessed using a system described by Matta. Results All patients were followed up for a mean period of 51.8 months （ranging from 1 year to 8 years and 10 months）. Matta＇s X-ray assessment show anatomic reduction in 71 cases, satisfactory in 34 and unsatisfactory in 17, yielding a rate of proper reduction as 86.1%. Clinically, 103 patients receiving operation within 3 weeks from injury showed excellent functional recovery in 66 cases, good in 23 cases, fair in 12 and bad in 2 （rate of satisfaction = 86.4%）, compared with excellent functional recovery in 3 cases, good in 4 cases, fair in 5 and bad in 7 （rate of satisfaction = 36.8%） for 19 cases treated after 3 weeks. Combined injuries included ectopic ossification （27 cases）, traumatic arthritis （19 cases）, acetabular erosion （1 case）, femoral head necrosis （3 cases）, fat liquefaction （3 cases） and superficial infection （1 case）. Of the three cases complicated with sciatic nerve injury, two showed varied recovery after operation. Conclusion while the quality of reduction is the key to treatment outcomes, it may be complicated by a number of factors. Comprehensive pre-surgical evaluation, optimal timing of operation, proper determination of the operative approach and precautions against operative complications may ensure improved clinical outcomes.