手术治疗髋臼合并同侧股骨干骨折42例临床分析

Clinical analysis of treatment of ipsilateral acetabular fracture and femoral shaft fracture in 42 cases

目的:总结髋臼合并同侧股骨干骨折的手术方法和治疗效果。方法:回顾性分析髋臼合并同侧股骨干骨折42例的临床资料。结果:42例患者平均随访15.8个月,根据Matta影像学评分,解剖复位25例,复位满意12例,不满意5例。根据D′Aubigné和Postel功能评分法,优21例(50.00%),良7例(16.67%),可11例(25.19%),差3例。根据Epstein影像学标准评价,优25例,良7例,可7例,差3例。发生股骨头坏死合并创伤性关节炎3例,异位骨化3例(7.14%)。无手术死亡、感染及骨折不愈合发生。结论:把握手术时机,准确评估骨折类型,选择正确的手术入路,配合术中灵活的处理,是提高疗效的关键。

Objective ：To improve the effect of operative treatment of ipsilateral acetabular fracture and femoral shaft fracture by an- alyzing the clinical experiences in the treatment of the fractures.Methods ：42 ipsilateral acetabular fracture and femoral shaft fracture were retrospectively reviewed.Femoral fractures were classified according to MUller classification.Results ：AU the cases were followed up for average 15.8 months.According to criteria of Matta radiographic grade, there were 25 cases of anatomic reduction, 12 of satisfactory re- duction,and 5 of unsatisfactory reduction.Based on the D＇Aubigne and Postel clinical grading system,21（50%） cases showed excellent re- suits,7（16.67%） cases good, 11（25.19%） cases fair and 3（7.14%） cases poor.According to criteria of Epstein radiographic grade,25 cases showed excellent results,7 cases good,7 cases fair and 3 case poor.Vascular necrosis of the femoral head and traumatic arthritis was found in 3 case （7.14%）,heterotopic ossification was found in 3 case （7.14%）.No death,infection or nonunion were found.Conclusion; Grasping operative opportunity, exact judgment of fracture type, reasonable surgical approaches and treatment in operation are essential to good results of ipsilateral acetabular fractures and femoral fractures.