髋臼骨折的CT分型与手术入路选择

CT-based classification and surgical approach selection of acetabular fractures

目的探讨应用髋臼骨折的CT分型指导手术入路选择，提高髋臼骨折的治疗水平。方法2002年12月至2007年9月间对21例髋臼骨折患者术前应用CT扫描，按髋臼骨折的Judet—Letoumel分型选择手术入路，4例后壁骨折、5例后柱骨折及2例横行骨折采用Kocher—Langeneback入路，2例前柱骨折、5例双柱骨折采用髂腹股沟入路；2例移位较重双柱骨折，采用前后联合入路；1例前壁骨折伴股骨头前上方骨折，采用髂股入路。采用专用器械及骨盆重建钢板和螺丝钉对骨折进行复位和固定；骨折距手术的时间为6—10d。结果随访6～57个月，平均18个月。术后骨折复位的质量按Matta影像学评定：解剖复位12例，良好复位8例，不满意复位1例。根据Merledd’Aubigne和Postel评分标准：临床疗效优13例，良5例，一般2例，差1例。结论CT扫描能明确髋臼骨折移位和粉碎程度，用术前CT分型指导手术入路的选择能提高手术治疗的临床效果。

Objective To explore the value of CT classification in the selection of operative approach and improving the clinical effect on aeetabular fractures. Methods From Dec. 2002 to Sep. 2007, twenty-one cases of acetabular fracture were examined with CT scan and classified according to Letournel and Judet classification. As a result of CT classification, the operative approaches were selected. The Kocher-Langenbeck approach was taken in 4 cases of posterior wall fracture, 5 cases of posterior column fracture and 2 cases of transverse fracture. The ilium-groin approach was taken in 2 cases of anteri- or wall fracture and 5 cases of double column fracture. Combined anterior and posterior approach was adopted in 2 cases of double column fracture with severe displacement. Iliofemoral approach was used in 1 case of anterior wall fracture associated with femoral head fracture. The operations were performed 6-10 days after injury and some special instruments, pelvic reconstructive plates and screws were utilized in the reduction and fixation of the fractures. Results All casesa had been followed up for 6-57 months with a mean of 18 months. The quality of fracture reduction was assessed with Matta assessment. Anatomical reduction was found in 12 cases, good in 8 and disaffect in 1. The clinical outcome was evaluated by Merled d ＇ Aubigne and Postel criteria , excellent result was got in 13 cases , good in 5 , fair in 2 , and poor in 1 Conclusion CT scan can well demonstrate the displacement and the extent of comminution of acetabular fractures, The CT classification instructed selection of operative approach can improve the clinical outcome of the surgical treatment.