切开复位内固定治疗髋臼骨折

Open Reduction and Internal Fixation for the Treatment of Acetabular Fractures

目的：探讨髋臼骨折的手术指征、最佳手术时机、入路选择、固定方法及并发症预防。方法：1996年3月~2008年3月手术治疗髋臼骨折64例,手术入路：后壁6例,后壁/后柱10例采用Kocher-Langenbeck切口;新鲜前壁前柱骨折、双柱骨折、横形骨折或T形骨折共31例采用髂腹股沟切口;髂股切口或延长的髂股切口治疗陈旧性髋臼骨折11例,6例复杂骨折采用前、后入路,即髂腹股沟切口＋Kocher-Langenbeck切口。内固定方法：2例髋臼后壁单发性骨折采用单纯螺钉固定,其余62例钢板固定。结果：手术后X片结果：骨折复位,优38例,良19例,中4例,差3例;复位优良率89%。随访12~24个月,按照Matta评分法：本组随访64例中,17分39例,15分20例,13分4例,11分1例;优良率92.1%。结论：准确地掌握手术时机、正确选择手术入路和骨折复位方法、精细的手术操作时取得理想复位的关键,良好的复位是取得满意疗效的基础。

Objective： To explore the surgical indications, best timing for surgery, selection of approaches, ways of fixation and prevention of complications of acetabular fractures. Methods：From March 1996 to March 2008, 64 cases with acetabular fracture received surgical treatment. The choices of approaches were as follows： posterior wall approach for 6 cases, posterior wall associated with posterior column approach for 10 cases with Kocher. Langenbeck opening, fresh fractures of anterior wall associated with anterior column, both column fractures or T shaped fractures of 31 cases via inguinal incision, inguinal incision or prolonged inguinal incision for 11 old acetabular fractures, and 6 complex fractures by anterior plus posterior approach with inguinal incision plus Kocher-Langenbeck incision. Two fractures of posterior wall were fixed with screws alone, and the rest 62 fractures were fixed with steel plate. Results： Post-operative X-ray examination showed that a- mong the 64 fractures, the results were rated as excellent in 38 cases, fine in 19 cases, medium in 4 and poor in 3, with the effective rate of reduction 89%. All cases were followed up for 12 to 24 months. According to Matta scoring, 39 cases got 17 points, 20 cases got 15 points, 4 cases got 13 points, and 1 case got llpoints; the excellent rate was 92.1%. Conclusion：Accurate timing of surgery, correct choice of approach and method of reduction as well as delicate surgical operation are all crucial to acquire ideal reduction.