髋臼骨折合并髋关节脱位的手术治疗

Surgical treatment of acetabulum fracture with dislocation of hip joint

[目的]探讨髋臼骨折的分型、手术入路、内固定方式及手术疗效。[方法]2001年11月～2006年8月,本院手术治疗的髋臼骨折合并股骨头脱位34例,根据髋臼骨折的AO分类标准:A型骨折24例,B型骨折10例,应用Kocher-Langenbeck(KL)手术入路20例,Gibson入路2例,KL改良入路4例,髂腹股沟入路4例,前后联合入路4例,内固定方式32例选用螺钉及钢板,2例应用钢丝环扎固定。[结果]所有患者获平均37.6个月随访。参照美国骨科学会(AAOS)提出的评价标准[1]:优12例,良12例,可4例,差6例,优良率为71%。[结论]结合全面的影像学资料,正确判断髋臼骨折的AO分型,恰当的手术入路及合适的内固定方式,同时注意手术时的微创操作及骨折复位的质量,才能提高疗效,减少并发症。

[ Objective ] To discuss the fractures classification, operative route, internal fixation and operative therapeutic effeetion of acetabular fractures. [ Method ] Thirty-four cases of aeetabulum fractures and femoral head dislocation were involved from November 2001 to August 2006 in our hospital throught operative treatment. The classification according of AO system：type A fractures 24 cases, type B 10 cases. Applieated Kocher-Langenbeek operative route was applied in 20 cases, Gibson route 2cases, illioinguinal route 4 cases and anteriorcombined posterior route 4 cases. Thirty-two cases were adopted reconstruction plates and screws and 2 cases steel-wire eerclage to fix fracture. All patients were followed up. [ Result] Acorrding to evaluation system of AAOS： excellent in 12 cases, good in 12 cases, fair in 4 cases, poor in 6 eases. Total exellence rate were 71%. [ Conclusion] Combinate full-scale imageology information, correct classification of fracture according of AO, reasonable surgical approach and fixation, correct subtle technique during the operation and effective fracture resetting are keys to improve the effect of acetabulax fractures.