髋臼骨折的手术治疗

Surgical treatment for acetabular fractures

目的 探讨髋臼骨折的手术方法和疗效。方法2001年3月至2006年3月共手术治疗髋臼骨折患者41例。按照Letoumel—Judet分型，简单型22例，复杂型19例，采用K-L入路31例（其中14例附加大转子截骨）、髂腹股沟入路8例，前后联合人路2例。重建钢板和螺钉固定。结果随访16。36（24．31±5．31）个月，根据Matta影像学评分标准，解剖复位27例，良好复位8例，差3例，关节轮廓复位3例。根据Merle D’Aubigne临床评定标准：优14例，良18例，一般5例，差4例，优良率78％（32／41）。股骨头坏死3例，异位骨化4例，创伤性关节炎3例，坐骨神经损伤4例，股神经损伤1例，神经损伤均在6个月内恢复。下肢深静脉栓塞3例，溶栓后恢复。无死亡病例，无感染、骨折不愈合等并发症。结论大多数髋臼骨折的手术可以通过单一的K-L入路或髂腹股沟人路完成显露。双钢板或单钢板＋拉力螺钉固定牢靠，可以满足髋关节早期功能锻炼的需要。

Objective To investigate the method and curative effect for the operative treatment of acetabular fractures. Methods Forty-one patients with acetabular fractures were treated operatively from March 2001 to March 2006. All fractures were classified according to the Letournel-Judet classification, 22 cases were simple fractures and 19 cases were complicated fractures. Kocher-Langenbeck （K-L） approach were adopted in 31 cases （14 cases through osteotomy of greater trochanter additionally）, ilioinguinal approach were adopted in 8 cases and anterior combined posterior approach were adopted in 2 cases. Different fractures were fixed by reconstructive plates and screws. Results All the patients were followed up for 16-36 （24.31± 5.31 ） months. According to the reduction criteria of Matta radiography, there were 27 cases with anatomic reduction, 8 cases with satisfactory reduction, 3 cases with poor reduction and 3 cases with joint contour reduction. According to the Merle D＇ Aubigne clinical criteria for joint functions, 14 cases showed excellent results, 18 cases were good, 5 cases were fair and 4 cases were poor, and the excellent-good rate was 78%（32/41 ）. Necrosis of the femoral head was found in 3 cases, heterotopic ossification in 4 cases, traumatic arthritis in 3 cases, sciatic nerve injury in 4 cases, femoral nerve injury in 1 case, all the nerve injury recovered in 6 months. Lower extremity deep venous thrombosis in 3 cases, all of them were recovered by given anticoagulation. No death, infection or nonunion were found. Conclusions K-L approach or ilioinguinal approach are adopted in the most of the operative treatment of acetabular fractures. Dual reconstructive plates or single reconstructive plate combine lag screws can fix solid. It can make hip to do early exercise.