移位髋臼骨折合并不稳定型骨盆后环损伤的临床特征及复位顺序

The clinical features and reduction sequence of displaced acetabular fractures associated with unstable posterior pelvic ring injuries

目的探讨移位髋臼骨折（displaced acetabular fracture，DAF）合并不稳定型骨盆后环损伤（posterior pelvic injury，PPI）的临床特征及复位顺序。方法1997年3月至2007年3月，资料完整的DAF合并PPI患者39例，合并同侧PP125例、对侧9例、双侧5例。根据AO／OTA分型方法，髋臼A型骨折9例，B型25例，C型5例；骨盆后环B型损伤31例，C型8例。DAF与PPI同期切开复位内固定33例，分期手术3例，另3例PPI行非手术治疗。术中首先复位DAF10例，首先复位PPI18例，DAF与PPI同时复位11例。结果术后随访12-120个月，平均33．7个月。根据Matta的评价标准，DAF解剖复位27例、复位满意4例、不满意8例。根据Mears的评价标准，PPI解剖复位24例、复位满意8例、不满意7例。其中因PPI移位而影响DAF满意复位者7例。DAF术后Matta功能评分为4～18分，平均14．7分。PPI术后Majeed疗效评分为51-100分，平均87．8分。以两个损伤部位的最低评分作为总体治疗结果，优25例、良3例、可2例、差9例。结论在处理累及髋臼双柱的DAF合并PPI时，PPI的准确复位是DAF获得满意复位的解剖基础，DAF的损伤类型及其复位质量是决定远期疗效的主要因素。

Objective To explore the clinical features and reduction sequence of displaced aeetabular fractures （DAF） associated with unstable posterior pelvic injuries （PPI）. Methods Thirty-nine patients with DAF combined PPI were treated from March 1997 to March 2007. The acetabular fractures with ipsilateral pelvic ring injuries were in 25 cases, contralateral injuries in 9, and both injuries in 5. According to AO/OTA classification, the partial intra-articular acetabular fractures affected a single column were in 9 cases, both-column in 25, complete acetabular fractures affected both-column in 5. The PPI rotationally unstable injuries were in 31 cases and rotationally combined vertically unstable type in 8. The open reduction and internal fixation of both injured pelvic ring and acetabulum in one-stage were for 33 cases and in twostage for 3. The DAF reduction was performed before PPI in 10 cases, after PPI in 18, and in the same time with PPI in 11. Results All patients were followed up for an average of 33.7 months （range, 12 to 120 months）. According to Matta＇s evaluation, the anatomical reduction of DAF was in 27 cases, satisfactory in 4, and unsatisfactory in 8. There were 7 cases unsatisfied DAF reduction influenced by PPI, and the mean hip functional score was 15.1 points （range, 4 to 18 points）. According to Mears＇s evaluation, the anatomical reduction of posterior pelvic injuries were in 24 cases, satisfactory in 8, and unsatisfactory in 7. The mean pelvis functional score was 87.8 points （range, 51 to 100 points）. The treatment outcomes were evaluated based on the lowest scores of the two injured portions, 25 cases showed excellent results, 3 good, 2 fare, and 9 poor. Conclusion The satisfied reduction of PPI is an anatomical basis for the reduction of DAF fractures. The type of fractures and reduction results of acetabulum fractures is the main factor to influence treatment results.