髋臼骨折治疗方法的选择

Treatment approach for acetabular fractures

目的探讨髋臼骨折治疗方法的选择。方法42例髋臼骨折按Letournel分类:Ⅰ型6例,ⅡA4例,ⅡB3例,ⅢA7例,ⅢB9例,ⅣA5例,ⅣB8例。手术采用K-L入路15例,髂腹股沟入路11例,髂股入路2例,前后联合入路5例;非手术治疗9例。结果42例均获得随访,时间4～30个月。X线片显示骨折均在12～16周愈合。根据美国矫形外科研究院评价髋关节功能标准:优24例,良10例,可6例,差2例,优良率80.95%。并发创伤性关节炎2例,异位骨化3例。结论早期对复杂髋臼骨折进行手术治疗,可获得满意的复位。选择合适的治疗方法对于减少手术创伤,准确复位骨折,减少手术并发症,促进关节功能恢复有重要意义。

Objective To investigate the selection of different methods to treat the acetabular fractures. Methods Forty two patients with acetabular fractures were accorded to Letournel classification：6 cases were typeⅠ , 4 cases were type Ⅱ A,3 cases were type Ⅱ B, 7 cases were type Ⅲ A, 9 cases were type Ⅲ B, 5 eases were type Ⅳ A, 8 cases were typeⅣB. Koeher- Langenbeek approach was adopted in 15 cases, ilioinguinal approach in 11 cases, iliofernoral approach in 2 cases, posterior-anterior approach in 5 cases ; and nonoperation in 9 cases. Results 42 cases were followed up for 4 - 30 months, and X-ray showed that the fractures were healed in 12 - 16 weeks. According to American Orthopaedic Surgery Academy standard of hip joint function： Excellent in 24 cases, good in 10 cases, fair in 6 cases and poor in 2 cases. The exeellenct and good rate was 80. 95%. Traumatic arthritis was found in 2 cases, and heterotopic ossification was found in 3 cases. Conclusions Satisfactory result can be procured through earlier opera- tion in the complexity acetabular fractures. It is very important for decreasing the surgical injuries and complications, reducing the fractures accurately and facilitating the recovery of the functions to select the appropriate approach.