陈旧性髋臼C型骨折的手术治疗

Operative treatment of delayed acetabular fractures of AO type C

目的探讨陈旧性髋臼C型骨折（AO分型）的手术疗效、入路选择和影响疗效的相关因素。方法2004年1月～2006年12月收治陈旧性髋臼C型骨折26例，其中C1型13例，C2型11例，C3型2例。受伤至手术时间：3～4周18例，5～6周5例，6周以上3例，其中最长1例68d，平均为31．6d。单纯或延长的Koche-Langenbeck入路6例，单纯髂腹股沟入路4例，髂股入路7例，联合入路9例。结果平均手术耗时255min，失血1840mL。所有患者获得8～52个月（平均15．5个月）随访。无死亡、急性感染发生，深静脉血栓形成3例，切口渗出1例，异位骨化5例。术后12周按照Matta标准对复位情况进行评估：解剖复位19例，满意复位5例，不满意复位2例，满意率92．3％。采用d＇Aubigne和Postel评分标准对关节功能进行评分：优16例，良5例，一般4例，差1例，优良率为80．8％。结论对于陈旧性髋臼C型骨折应争取尽早解剖复位，并进行积极的术后功能锻炼。手术切口的选择应根据骨折类型、医生的手术经验和伤后手术时机决定。

Objective To study the efficacy, choice of approach and clinical outcomes of surgical treatment of delayed acetabular fractures of AO type C. Methods From January 2004 to December 2006, 26 cases of delayed acetabular fractures of AO type C were treated operatively. They were 17 males and 9 females with an average age of 39. 5 years （21 to 57 years）. They included 13 cases of C1 type, 11 cases of C2 and 2 cases of C3 type. The interval between injury and surgery averaged 31.6 days. Six cases were treated through Kocher-Langenbeck or extended approach, 4 cases through ilio-inguinal approach, 9 cases through iliofemoral approach, and 7 through combined approaches. Results The mean operation time was 255 min （150 to 495 min）. The average blood loss was 1840 mL. The mean follow-up period was 15.5 months （8 to 52 months）. No death or acute infection occurred. Heterotopic ossification developed in 5 and DVT in 3 cases. Evaluation was conducted with Matta reduction standard and modified d＇ Aubigne and Postel clinical scoring 12 weeks postoperatively. Anatomical reduction was achieved in 19 cases, satisfactory in 4 and poor in 2. Satisfactory reduction rate was 92.3%. Sixteen cases had excellent joint score, 5 good, 4 fair and 1 poor. The excellent to good rate was 80. 8%. Conclusions In principle, early and anatomic reduction and active functional exercise after operation are important for efficacy of operative treatment of delayed acetabular fractures of AO type C. The operation approach should be decided according to the fracture type, experience of the surgeon and timing of operation.