83例移位髋臼骨折的临床分型及外科治疗

Clinical Classification and Surgical Management of Displaced Acetabular Fractures

目的探讨移位髋臼骨折的分型、手术方法选择和治疗效果。方法 2004年1月-2009年3月,采用骨盆重建钢板治疗移位髋臼骨折患者83例,男性59例,女性24例;年龄19～72岁,平均41.2岁;左侧40例,右侧43例。骨折按照Letournel-Judet标准分型,分别采用Kocher-Langenbeck入路、髂腹股沟入路及前后联合入路进行手术治疗。结果 83例平均随访24.5个月(12～36个月)。按照Matta骨折复位标准,解剖复位49例,满意复位31例,复位不良3例。骨折均获愈合,根据改良的Merle d’Aubigne和Postel评分系统,优42例,良29例,可10例,差2例,优良率85.5%。术后发生医源性坐骨神经损伤2例,股骨头坏死3例,异位骨化8例,创伤性关节炎5例。结论术前正确判断骨折类型、及时手术、选择恰当的手术入路、解剖复位牢固固定,以及早期功能锻炼是提高移位髋臼骨折疗效的关键。

Objective To determine the classification, the selection of the operative method and operative restdts for displaced aeetabular fractures. Methods From January 2004 to March 2009,83 patients with displaced aeetabular fractures were treated by open reduction and internal reconstructive plate fixation. There were 59 males and 24 females, with a mean age of 41.2 years （range, 19 to 72 years）. Koeher-l.angenbeck approach, ilioinguinal approach and anterior combined posterior approach were a- dopted for different fractures. Results All patients were followed for mean 24.5 months （ 12-36 months）. According to the Mat- ta＇ s standard of replacement of fracture, there were 49 cases with anatomic reduction ,31 with satisfactory reduction ,3 with unsat- isfactory reduction. Fracture union was obtained in all the patients. Based on the modified Merle d＇ Aubigne and Postel clinical grading system,the result was excellent in 42 patients,good in 29 ,fair in 10 and poor in 2 ,with excellence rate of 85.5%. Postoperative complications included iatrogenic sciatic nerve injury in two patients,femoral head avascular necrosis in 3 ,heterotopic os- sification in 8 and traumatic arthritis in 5. Conclusion Correct classification, operation on time, reasonable surgical approaches, anatomic reduction, stable internal fixation and early functional rehabilitation are keys to providing satisfactory outcome for dis- placed aeetabular fracture.