手术治疗髋臼骨折38例分析

Surgical Treatment of 38 Patients with Acetabular Fractures

目的探讨手术治疗髋臼骨折的临床疗效。方法髋臼骨折38例按照Letoumel和Judet分型方法进行分型。手术入路：经Kocher—Langenbeck切口30例，经髂腹股沟切口7例，采用联合切口1例。结果解剖复位（移位〈1mm）30例，满意复位（移位2—3mm）6例，不满意复位（移位〉3mm）2例。38例患者均得到随访，随访时间6个月至4年，平均2．1年。按D，Aubigne和Postel髋关节评分标准评定，优31例，良5例，尚可1例，差1例，优良率81．5％。结论正确分析骨折移位和类型、选择适当的手术路径是提高髋臼骨折治疗效果的重要保证，手术疗效与骨折复位质量密切相关。

Objective To investigate the clinical effect of surgical treatment of acetabular fractures. Methods According to Letournel and Judet typing, 17 cases of posterior wall fractures, 5 cases of transverse fractures, 3 cases of anterior wall fractures, 2 cases of anterior column fractures ,5 cases of transverse and posterior wall fractures, 2 cases of posterior column and wall fractures, 2 cases of T-type fractures , 1 case of anterior and hemi-transverse fractures and 1 case of fractures of both column）. Kocher Langenbeck （K-L） approach was applied in 30 cases, ilioinguinal approach in 7, and combined approaches （K-L plus ilioinguinal） in 1. Results According to Matta evaluation, anatomical reduction（ displace 〈 1 mm）was applied in 30 patients. Satisfactory reduction（ displace 2 - 3 mm） was attained in 6 patients, unsatisfactory reduction（ displace 〉 3mm） was in 2 patients. 38 patients were followed up for 6 - 48 months （ mean： 25 months）. The hip function was evaluated according to the modified Postel-D, Aubigne score and rated as excellence in 31 patients （ 81.5 % ）, good in 5 patients （ 13.1% ）, fair in 1 patient （ 2.6% ） and poor in 1 patient（ 2. 6% ）. The excellent and good rate was 81.5%. Conclusions It is the important guarantee to elevate the therapeutic efficacy of acetabular fracture that shoud be correctly analyze the fracture displacement and type, choose proper surgical approach, have good restitution implement and operate at the right moment. The quality of surgical reduction has a close correlation with the clinical results.