髋臼粉碎性骨折合并骨缺损的治疗

Treatment of comminuted acetabular fractures with bone defects

目的探讨髋臼粉碎性骨折合并骨缺损的治疗方法。方法回顾性分析1998年7月-2004年2月我科收治72例髋臼粉碎性骨折合并骨缺损病例资料,44例复杂骨折,28例简单骨折;缺损体积3-9 cm3,平均4.5 cm^3。采用后外侧入路、前后联合入路和改良髋臼入路,应用髋臼三维记忆内固定系统进行骨折内固定。结果平均随访时间25.5个月（5-86个月）,59例达到解剖复位,X线检查评估,优25例,良34例,一般8例,差5例。55例获得满意的髋关节功能且无痛,12例偶感轻微疼痛,5例行走时稍感疼痛。2例股骨头缺血性坏死,2例异位骨化,1例创伤后髋关节炎。结论利用髋臼骨折记忆合金三维内固定系统（ATMFS）治疗髋臼粉碎性骨折合并骨缺损,有效地提高了股骨头与髋臼解剖对应率,为髋关节功能的恢复提供了有效的手段。

Objective To discuss the therapy method of comminuted acetabular fractures with bone defects. Methods From Jul. 1998 to Feb. 2004,72 cases of comminuted acetabular fracture with bone defects were treated. There were 44 cases of complex fractures and 28 cases of simple fractures. The defect volume was 3cm^3-9cm^3 ,average 4.5cm^3. Through the regular or modified approach, these cases were treated with ATMFS （ acetabular tridimensional memory-fixation system ）. Results Follow-up ranged from 5 months to 86 months （ mean ： 25.5 months ）. Fifty-nine cases with anatomical reduction had an excellent or good radiological result ,fair in 8 and poor in 5. Fiftyfive cases were pain free and had satisfactory hip function,while 12 had minor and occasional pain. Five cases complained of slight pain under weight-bearing. Avascular necrosis of the femoral head occurred in 2 cases. Heterotopic ossification occurred in 2 cases and another 1 case had severe post traumatic arthritis which led to hip arthroplasty surgery. Conclusion The method of fixation of ATMFS for acetabular fractures with bone defects,which improves the reduction rate of acetabulum and femoral head, is an effective method for restoring hip function.