髋臼双柱骨折术后异位骨化的相关因素分析

Factors related to heterotopic ossifications after treatment of bi-columnar acetabular fractures

目的探讨髋臼双柱骨折术后并发异位骨化（HO）的影响因素。方法自2001年4月至2006年12月，采用手术治疗并获得随访的193例髋臼双柱骨折患者中，男147例，女46例，平均年龄34．4岁；合并颅脑外伤31例。损伤1周内手术者15例，1～2周者121例，2～3周者34例，超过3周者23例。回顾性对手术方法、伴发损伤、伤后延迟手术时间等因素进行分析，探讨其对髋臼双柱骨折术后HO形成的影响。结果手术平均耗时238min（150～330min），术中平均出血1453mL（450～4400mL）。平均随访44．2个月（14～84个月），HO发生率为39．9％（77／193），其中Ⅰ度39例，Ⅱ度23例，Ⅲ度15例，手术时间与HO严重程度无显著相关（R=0．207，P=0．071）。其中颅脑外伤组14例，非颅脑外伤组63例，两组HO的发生率差异无统计学意义（X^2=0．019，P=0．891）；伤后不同时期内手术后HO发生情况分别为：1周内2例，1～2周者38例，2～3周者21例，大于3周者16例，延迟不同手术时间的HO发生率差异有统计学意义（X^2=21．89，P〈0．05）；HO分级与疗效无显著相关（R=0．041．P=0．722）。手术切15中清除坏死的臀小肌后，仅15例（7．8％）发生严重的HO。结论髋臼双柱骨折术后HO的形成与是否伴有颅脑外伤无显著相关，与延迟手术时间高度相关，清除坏死臀小肌和手术区域其他坏死肌肉可以减少术后HO的形成。

Objective To discuss factors influencing the heterotopic ossifications （HO） after treatment of bi-column acetabular fractures. Methods One hundred and ninety-three cases of bi-column acetabular fractures were followed up, including 147 males and 46 females with an average age of 34. 4 years. Thirty-one cases were associated with craniocerebral trauma. The interval between injury and surgery was less than 1 week in 15 cases, 1 to 2 weeks in 121 cases, 2 to 3 weeks in 34 cases, and over 3 weeks in 23 cases. Factors that might have influenced HO, including surgical method, associated injury, and interval between injury and surgery, were analyzed retrospectively. Results All the cases were followed up for an average of 44. 2 （14 to 84） months. The mean operation time was 238 （150 to 330） minutes, and the average blood loss was 1453 （450 to 4400） mL. The incidence rate of HO was 39.9% （77 in 193 cases）, including 39 cases of degree one, 23 cases of degree two, and 15 cases of degree three. Of the 77 cases associated with HO, 14 had cranioeerebral trauma and 63 did not （X^2 = 0. 019, P = 0. 891）. HO was found in 2 cases that had been operated on in less than 1 week, 38 cases in 1 to 2 weeks, 21 cases in 2 to 3 weeks, and 16 cases in over 3 weeks. The Spearman correlation analysis between HO degree and clinical result showed no correlation （ R = 0. 041, P = 0. 722）. Only 15 cases （7.8%） were associated with HO after the debridement of the necrotic gluteus minimus. Conclusions HO after surgery for bi-column acetabular fractures may not be correlated with craniocerebral trauma, but highly correlated with the interval between injury and surgery. Debridement of necrotic gluteus minimus and other muscles can reduce the incidence of HO.