影响髋臼后壁骨折手术疗效的因素分析

Analysis of correlative factors influencing the operative results of posterior wall fractures of the acetabulum

目的 探讨影响髋臼后壁骨折手术疗效的因素。方法 1990年5月至2003年11月，共手术治疗髋臼后壁骨折88例，年龄17～67岁，平均40岁。根据可能影响手术疗效的若干因素，如复位质量、伤后至股骨头复位时间、伤后至手术时间、患者年龄及骨折粉碎程度等对患者进行分组和分析。结果 88例平均随访时间8年（3-16年）。按Matta等标准评定，手术疗效：优74例（84．09％），良9例（10．23％），可4例（4．55％），差1例（1．14％），优良率为94.32％；X线疗效：优76例（86.36％），良9例（10．23％），可3例（3.41％），优良率为96．59％。临床优良率在解剖和非解剖复位组分别为96.30％和71.43％；在伤后至股骨头复位时间〈24h和≥24h组分别为98．11％和85．71％；在伤后至手术时间〈3周和≥3周组分别为96．20％和77．78％；在年龄〈50岁和≥50岁组分别为97．30％和78．57％；在骨折粉碎〈3块和≥3块组分别为96．15％和80％；以上各因素的手术疗效比较，经统计学分析显示差异有统计学意义（P〈0．05）。结论 复位质量、伤后至股骨头复位时间、伤后至手术时间、年龄和骨折粉碎程度等因素均对髋臼后壁骨折手术疗效产生显著影响，避免影响疗效的不利因素有助于改善手术疗效。

Objective To explore correlative factors influencing the operative results of posterior wall fractures of the acetabulum. Methods Eighty-elght patients with the posterior wall fractures of the acetabulum treated by open reduction and internal fixation admitted from May 1990 to November 2003 were reviewed, which included 4 females and 84 males, with the mean age of 40 years （range, 17-67 years）. The patients were grouped according to some influential factors such as the quality of fracture reduction, the time to reduction of hip dislocation after injury, the time to surgery after injury, the age and the degree of fracture comminution that related to the operative results. All data were analyzed. Results The average follow-up of all cases was 8 years （range, 3-16 years）. According to Matta meliorated score, 74 cases were excellent, 9 good, 4 fair and 1 poor. According to radiographic standard assessment, 76 cases were excellent, 9 good and 3 fair. Excellent and good rates for operative results and radiographic results were 94.32% and 96.59% respectively; Excellent and good rates for operative results in anatomical and nonanatomical reduction group were 96.30% and 71.43% respectively. As the time to reduction of hip dislocation after injury, excellent and good rates was 98.11% in the group of 〈 24 h, and 85.71% in the group of≥24 h. As the time to surgery after injury, excellent and good rates was 96.20% and 77.78% in the group 〈3 weeks and ≥3 weeks respectively. In the age 〈 50 years old and ≥50 years old group, the excellent and good rates were 97.30% and 78.57% respectively. In the fracture comminution 〈 3 fragments and ≥3 fragments group, the excellent and good rates were 96.15% and 80% respectively. The differences between each factor group and operative results were significant （P〈 0.05）. Conclusion The quality of fracture reduction, the time to reduction of hip dislocation after injury, the time to surgery after injury, age and the degree of fracture comminution are the factors influencing the operative results of posterior wall fractures of the acetabulum. Understanding and avoiding the unfavorable influences of the factors will predict and improve the operative results.