陈旧性髋臼骨折的手术治疗

Operative treatment of delayed acetabular fracture

目的探讨陈旧性髋臼骨折手术治疗方法和效果。方法1998年6月～2006年12月手术治疗陈旧性髋臼骨折22例。骨折按Letounel-Judet方法分型,其中后壁骨折6例,后柱伴后壁骨折2例,横形骨折3例,横形伴后壁骨折2例,"T"形骨折1例,前柱伴后半横形骨折3例,双柱骨折5例。根据不同骨折类型,手术采用Kocher-Langenbeck(K-L)入路8例,髂腹股沟入路2例,前后联合入路12例。结果根据MATTA的影像学复位标准:解剖复位11例,良好复位7例,差2例,关节轮廓复位2例。所有病例随访1～5年,平均2.5年。根据Merle d'Aubigne的临床评定标准:临床疗效优良率73%(16/22),解剖复位和非解剖复位的疗效优良率分别为72%(13/18)和25%(1/4)(χ2=65.5,P<0.01)。结论陈旧性髋臼骨折手术疗效与复位质量密切相关,正确选择手术切口入路和复位内固定可获得相对满意的疗效。

[ Objective ] To discuss the method and result for operative treatment of delayed acetabular fracture. [Methods] 22 patients with delayed acetabular fracture were treated operatively from June 1998 to December 2006. According to Letournel-Judet classification, there were 6 cases with posterior wall fracture, 2 with posterior column and wall fracture, 3 with transverse fracture, 2 with transverse and posterior wall fracture, 1 with T shaped fracture, 3 with anterior colunm and hemi-transverse fracture and 5 with fracture of both column. According to different types of fracture, Kocher-Langenbeck （K-L） approach was applied in 8 cases, ifioinguinal approach in 2, anterior combined posterior approach in 12. [ Results ] According to reduction criteria of Matta radiography, there were 11 cases with anatomic reduction, 7 with satisfactory reduction, 2 with poor reduction, 2 with joint contour reduction. The follow- up time was 1--5 years, averaged 2.5 years. According to Merle d＇Aubigne clinical criteria, the total excellence rate of clinical result was 73% （16/22）, with excellence rate in anatomic and non-anatomic reduction groups for 72% （13/ 18） and 25% （1/4） respectively, with a very significant difference （X2=65.5, P 〈0.01）. [Conclusion] The operative result of delayed acetabular fracture has a close correlation with the quality of reduction. Good result can be obtained to select proper incision approach, operative reduction and internal fixation.