髋臼骨折手术治疗的回顾性分析

Operative management of acetabular fractures： a retrospective analysis of 46 cases

目的探讨髋臼骨折的诊断、手术方法及治疗效果。方法从1999年1月至2006年12月，共手术治疗髋臼骨折46例48髋，其中A型骨折18髋，B型骨折22髋，C型骨折8髋。手术采用髂腹股沟入路6髋，K—L入路27髋，前后联合入路（髂腹股沟＋K．L入路）13髋，延长的髂股入路2髋。结果解剖复位32例（66．7％），复位满意11例（22．9％），复位不满意5例（10．4％）。随访4个月～4年，平均2年5个月。按改良D’Aubigne和Postel评分标准评定关节功能：优26髋，良9髋，可9髋，差4髋，优良率为72．9％（35／48）。结论术前CT三维重建对骨折准确分型和选择合理的手术入路具有重要作用；术前在骨盆标本上模拟手术并初步预弯重建钢板，对缩短手术时间、提高手术效果有很大帮助；术中对骨折在尽可能地解剖复位，并可靠内固定是取得良好疗效的基础。

Objective To discuss our experience of diagnosing and treating acetabular fractures. Methods From January 1999 to December 2006, a total of 48 acetabular fractures in 46 patients were treated surgically, including 18 hips of Type A, 22 hips of Type B, and 8 hips of Type C. Ilioinguinal approach was adopted in 6 hips, Kocher-Langenbeck approach in 27 hips, combined anterior and posterior approach （Ilioinguinal plus Kocher-Langenbeck） in 13 hips, and extended iliofemoral approach in 2 hips. Results Anatomical reduction was obtained in 32 hips （66. 7% ）, satisfactory reduction in 11 hips （22. 9% ） and poor reduction in 5 hips（10.4% ）. All the cases were followed up for 4 months to 4 years, with an average of 29 months. They were evaluated according to D＇Aubigne and Postel criteria for joint functions. Twenty-six hips were rated as excellent, 9 hips as fine, 9 hips as fair and 4 hips as poor. The good-excellent rate was 72.9%. Conclusions CT three-dimensional reconstruction is a great help for a doctor to make accurate diagnosis of the type of complex acetabular fractures and thus select an appropriate operative approach. Preoperative simulation in vitro on a pelvic specimen also helps a doctor reduce operative time and improve operative results. Maximal anatomical reduction and good internal fixation are essential for satisfactory outcome.