不同髋臼横行骨折手术入路的选择

Surgical approach selection in different type of transverse acetabulum fractures

目的探讨改良Judet-Letournel分型系统在不同髋臼横行骨折手术入路选择中的临床意义。方法本组共13例横行骨折患者,其中B1.1型2例,B1.2型4例,B1.3型7例;修正因子a1有4例,a2有2例,a3有5例,a4有2例。切开复位内固定手术采用髂腹股沟入路的有3例,Kocher-Lan-genbeck入路有6例,前后联合入路有4例。术后通过Matta’s标准评分评价影像学结果,用改良Merled’Aubigne评分评估临床结果。结果平均32个月随访证实本组患者所有的骨折达到愈合,平均骨折愈合时间17.3周。解剖学复位7例,复位欠佳4例,复位差2例。修正因子a1/a2患者中解剖学复位83.3%,修正因子a3/a4患者为28.6%。临床评分平均15.3,9例(69.2%)满意;4例(30.8%)不满意。7例解剖学复位者临床效果满意。结论髋臼横行骨折手术入路的选择取决于横行骨折的水平及倾斜度、移位程度和旋转程度,以及是否合并后壁骨折。改良Judet-Letournel分类结合了传统髋臼解剖学分类和AO分型在预后评估上的优点,对于髋臼横行骨折手术计划具有重要意义。

Objective To explore the clinical significance of the modified Judet-Letournel classifi cation in the surgical approach selection for different types oftransverse acetabulum fractures. Methods 13 cases of transverse acetabular fractures were in this series, among which 2 cases were of type B1.1, 2 cases of B1.2 and 7 cases of B1.3 ; 4 patients had modified factor al, 2 had a2, 5 had a3 and 2 had a4. Open reduction and internal fixation were performed in all eases, the anterior ilioinguinal approach was used in 3 eases, the posterior approach was in 6, and the combined approach was in 4. Postoperative radiographic results were evaluated by Matta＇ s criteria and the final clinical results were defined by the modified Merle d＇ Aubigne scoring system. Results A mean follow-up of 32 months revealed that all the aeetabu- lar fractures healed in this series with a mean healing time of 17.3 weeks. Postoperative radiology revealed anatomical reduction in 7 eases, imperfect reduction in 4, and poor reduction in 2. The ratio of anatomical reduction in modified factor a1/a2 was 83.3% , thus a3/a4 was 28/6%. According to the clinical results, 9 patients had satisfactory results （69. 2% ）, and 4 had unsatisfactory results （30.8%）. 7 patients with anatomical reduction had satisfactory result. Conclusion The selection of surgical approach in transverse aeetabular fractures depends on the level and draw of the fracture, the extent of displacement and rotation, and the combination of the posterior wall fracture. The modified Judet-Letournel classification which combined the virtue of anatomy classification and AO elaasifieation is signifieant in surgical planning for transverse aeetabular fractures.