移位髋臼骨折的手术治疗

Operative treatment of displaced acetabular fractures

目的 探讨移位髋臼骨折的手术治疗及提高疗效的方法.方法 总结2000年6月-2008年9月对46例移位髋臼骨折患者的手术治疗经验.根据Letournel-Judet分型：双柱骨折15例,横行伴后壁骨折11例,＂T＂形骨折8例,后柱伴后壁骨折8例,前柱伴后壁骨折4例.分别采用Kocher-Langenbeck入路（K-L入路）、髂腹股沟入路、前后联合入路进行切开复位重建钢板内固定治疗.结果 46例患者获得随访6个月～8年（平均3.9年）.按改良的Merle d＇Aubigne和Postel评分标准进行评定：优23例,良14例,一般7例,差2例,优良率为80.4%.术后发生脂肪液化2例（4%）,医源性坐骨神经损伤2例（4%）,股骨头坏死3例（7%）,异位骨化3例（7%）,创伤性关节炎4例（9%）,无手术死亡或骨不愈合发生.结论 术前正确判断骨折类型及移位方向、选择适当的手术时机和入路,以及术中良好的复位和内固定是提高移位髋臼骨折疗效的关键.

Objective To discuss operative treatment method for displaced acetabular fractures so as to improve the curative effects.Methods A retrospective study was done on data of 46 patients with displaced acetabular fractures treated operatively from June 2000 to September 2008.According to Letournel-Judet classification,there were eight patients with posterior column fractures combined with posterior walk fractures,four with anterior column fractures combined with posterior wall fractures,11 with transverse fractures combined with posterior wall fractures,eight with type T fractures and 15 with doublecolumn fractures.All patients were treated with open reduction and internal reconstructive plate fixation through Kocher-Langenbeck,iloinguinal or anteroposterior approaches respectively.Results All patients were followed up for 6 months to 8 years（average 3.9 years）.According to modified Merle d＇ Aubigne and Postel score criteria,the result was excellent in 23 patients,good in 14,fair in 7 and poor in 2,with excellence rate of 80%.Postoperative complications included fat liquefaction in two patients（4%）,iatrogenic sciatic nerve injury in two（4%）,femoral head necrosis in three（7%）,heterotopic ossification in three（7%）and traumatic arthritis in four（9%）,with no operative death or nonunion occurred.Conclusions Preoperative accurate assessment of fracture type and displacement direction,appropriate selection of operation time and surgical approach as well as good operative reduction and internal fixation are key to providing satisfactory outcome for displaced acetabular fractures.