应用髋臼镍钛记忆合金三维内固定系统治疗髋臼后壁骨折伴髋关节后脱位

APPLICATION OF ACETABULAR TRIDIMENSIONAL MEMORYALLOY-FIXATION SYSTEM IN TREATMENT OF POSTERIOR WALL ACETABULAR FRACTURE WITH POSTERIOR DISLOCATION OF HIP

目的探讨髋臼镍钛记忆合金三维内固定系统(acetabular tridimensional memoryalloy-fixation system,ATMFS)治疗髋臼后壁骨折伴髋关节后脱位的方法及临床效果。方法2004年1月-2006年2月,收治15例髋臼后壁骨折伴髋关节后脱位患者。男11例,女4例;年龄21～68岁,平均43.5岁。交通伤8例,高处坠落伤5例,其他伤2例。左侧9例,右侧6例。骨折根据Thompson-Epstein分型:Ⅱ型6例,Ⅲ型5例,Ⅳ型2例,Ⅴ型2例。影像学检查示髋臼关节面存在2～5mm移位,平均3mm。伤后至入院时间为6h～2周,平均1.5d。入院后行股骨髁上骨牵引,12例手法复位,3例股骨头卡压者于术中复位。入院后2～7d采用ATMFS固定骨折,其中4例骨缺损者采用自体髂骨植骨修复。结果手术时间90～390min,平均210min。术中失血量350～2500mL,平均360mL。住院日7～21d,平均10d。1例于术后4d出现表皮感染,经对症处理后愈合;余切口均Ⅰ期愈合。无深部感染、肺栓塞、下肢深静脉血栓等并发症发生。患者均获随访,随访时间1～3年,平均1.6年。术后出现股骨头坏死及BrookerⅡ级异位骨化各1例,髋关节功能尚好,未作特殊处理。术后1周采用Matta的X线标准评估骨折复位:优7例,良5例,一般2例,差1例,优良率为80%。末次随访时采用d’Aubigné等临床评定标准评价临床疗效:优8例,良5例,一般1例,差1例,优良率86.7%。结论ATMFS治疗髋臼后壁骨折伴髋关节后脱位,可有效提高股骨头与髋臼解剖对应率,减少髋臼骨折并发症的发生以及促进髋关节功能恢复,远期疗效需进一步观察。

Objective To investigate the clinical effect of the acetabular tridimensional memoryalloy-fuxation system （ATMFS） in treatment of posterior wall acetabular fractures with posterior dislocation of hip. Methods From January 2004 to February 2006, 15 cases of posterior wall acetabular fracture with posterior dislocation of hip were treated. There were 11 males and 4 females, aged 21-68 years old with an average of 43.5 years old. Injury was caused by traffic accident in 8 cases, by falling from height in 5 cases and others in 2 cases. The locations were the left hip in 9 cases and the right hip in 6 cases. According to Thompson-Epstein＇ fracture classification, there were 6 cases of type Ⅱ, 5 cases of type Ⅲ, 2 cases of type Ⅳ and 2 cases of type Ⅴ. Imaging showed the acetabular articular surface displacement of 2-5 mm（mean 3 ram）. The time from injury to hospitalization was 6 hours to 2 weeks（mean 1.5 days）. Skeletal traction on femoral condyle was given, manual reduction was performed in 12 patients and intra-operative reduction in 3 cases. ATMFS was used after 2-7 days of hospitalization, and 4 cases received autologous free ilium because of bone defect. Results The operative time was 90-390 minutes with an average of 210 minutes. Intraoperative blood loss was 350-2 500 mL with an average of 360 mL. The hospitalization days of the patients ranged from 7 to 21 days（mean 10 days）. Epidermal infection occurred and was cured after symptomatic management in 1 case. Other incisions healed by first intention. No deep infections, pulmonary embolism, deep venous thrombosis and other complications occurred. The patients were followed up 1 to 3 years with an average of 1.6 years. Ischemic necrosis of femoral head occurred in 1 case. Heterotopic ossification in grade Ⅱ occurred in 1 case. The hip function was still good without special treatment. According to Matta＇s X-ray fracture reduction assessment, the results were excellent in 7 cases, good in 5 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 80%. According to d＇Aubign6 clinical efficacy evaluation, the results were excellent in 8 cases, good in 5 cases, fair in 1 case, and poor in 1 case, the excellent and good rate was 86.7% at last followup. Conclusion ATMFS can be used for the treatment of posterior wall acetabular fracture with posterior dislocation of hip, which can improve the anatomy corresponding rate of the femoral head and reduce the incidence of complications and restore the function of the hip.