影响移位性髋臼骨折手术疗效的因素

Analysis of prognostic factors of the operative outcomes of displaced acetabular fractures

目的探讨影响移位性髋臼骨折手术疗效的因素。方法2000年6月至2006年10月，手术治疗移位性髋臼骨折124例（125髋），年龄20-75岁，平均39．7岁。根据可能影响手术疗效的因素，如年龄、性别、骨折类型、合并同侧髋关节后脱位、髋关节复位时间、合并同侧坐骨神经损伤、伤后手术时间、手术入路、骨折复位质量、异位骨化等对患者进行分组，并进行Logistic回归分析。结果118例（119髋）获得随访，平均随访32．5个月（12-76个月）。按改良Merled d＇Aubigne-Postel评分标准，优51髋、良44髋、可16髋、差8髋，优良率为79．8％。功能优良率在简单类型骨折和复杂类型骨折组分别为88．9％和69．6％ （x^2=6．763，P=0．009）；14d内手术和14d后手术组分别为85．9％和68.3％（x^2=5．130，P=0．024）；复位满意组和不满意组分别为86．8％和18．2％（x^2=29．450，P=0．000）；无髋关节脱位、髋关节脱位24h内复位组和24h后复位组分别为85．9％、8412％和40．0％，24h内复位组与无髋关节脱位组比较差异无统计学意义（x^2=0．000，P=1．000），24h后复位组的优良率低于无髋关节脱位组（x^2=13．532，P=0．000）和24h内复位组（x^2=5．369，P=0．020）。多因素Logistic回归分析显示骨折类型、髋关节后脱位复位时间、伤后手术时间、复位质量是影响髋臼骨折术后功能结果的独立危险因素。结论复位质量、髋关节后脱位复位时间、骨折类型及伤后手术时间是影响髋臼骨折术后功能的独立危险因素，其中复位质量是最重要的可控性因素。

Objective To explore correlative factors influencing the operative functional outcomes of displaced acetabular fractures. Methods From June 2000 to October 2006, 124 patients （125 hips）with displaced acetabular fractures were treated. There were 101 males and 23 females, with mean age of 39.7 years. The clinical outcomes were assessed using the scoring system of Merle d＇Aubigne-Postel. A statistical model was constructed comprising the clinical outcome and the postulated prognostic factors. The association between these factors and outcome was explored by Logistic regression. Results 118 patients （119 hips） were followed-up. The average follow-up period was 32.5 months. According to the modified Merle d＇Aubigne-Postel hip score, 51 hips were graded as excellent, 44 good, 16 fair and 8 poor. Excellent and good rates for functional outcomes in simple and associated fracture type group were 88.9% and 69.6%. As the time to surgery after injury, excellent and good rates was 85.9% and 68.3% in the group in which less than 2 weeks and in the group in which more than 2 weeks respectively. As the quality of fracture reduction, excellent and good rates was 86.8% in the satisfactory reduction group, and 18.2% in the unsatisfactory group. As the time to reduction of hip dislocation after injury, excellent and good rates was 84.2% in the group in which less than 24 h, and 40.0% in the group in which more than 24 h. Conclusion The quality of fracture reduction, the time to reduction of hip dislocation, the fracture type and the time to surgery are independent risk factors of functional outcomes. The quality of fracture reduction is the most important controllable one.