开窗法复位植骨内固定治疗髋臼前柱骨折合并臼顶区关节面压缩塌陷的临床研究

Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome

目的:探讨开窗法复位植骨内固定和单纯行前柱复位内固定治疗髋臼前柱骨折合并臼顶区关节面压缩塌陷的治疗效果。方法:2005年7月至2007年2月,收治合并有臼顶区关节面压缩塌陷的髋臼前柱骨折52例,其中24例采用开窗法整复关节面、植骨后再行前柱复位内固定治疗,男17例,女7例;年龄(35.2±6.4)岁;28例单纯行前柱复位内固定,男19例,女9例;年龄(36.4±4.8)岁。所有患者术后采用改良d'Aubigne Postel功能评分标准进行评估,比较髋关节功能改善情况。结果:所有患者均达到骨性愈合,出现股神经损伤1例,术后2个月恢复,无其他并发症发生。52例患者术后获得随访,时间12～51个月,平均31.5个月。根据改良d'AubignePostel功能评分,两组患者在疼痛、行走、关节活动范围、总评分比较差异有统计学意义。开窗法治疗组:优13例,良9例,可1例,差1例;单纯前柱复位组:优9例,良11例,可6例,差2例(u=0.613,P<0.05)。结论:开窗法复位植骨内固定治疗髋臼前柱骨折合并臼顶区关节面压缩塌陷是一种可行的方法,且可明显改善髋关节功能。

Objective：To analyze the fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome. Methods：From July 2005 to February 2007,52 cases of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome were treated by two methods. Among them,24 cases were treated by fenestration operation for articular facet reduction,bone grafing,anatomical reconstruction of the acetabular papastyle with internal fixation,incuded 17 males and 7 females with an average age of（35.2±6.4） years old;the other 28 cases were treated only anatomical reconstruction of the acetabular papastyle with internal fixation,included 19 males and 9 females with an average age of（36.4±4.8） years old. All the patients were evaluated with modified d＇Aubigne-Postel clinical evaluation standard. Results：All patients gained bone healing. There were only 1 patient occurenced femoral nerve injury and recovered 2 months later. There were no other complications. All patients were followed up from 12 to 51 months （averaged in 31.5 months）. According to modified d＇Aubigne-Postel clinical evaluation standard,there were statistic difference between the two groups of patients in pain,walking,range of motion and total score. In fenestration operation group,the results were excellent in l3 patients,good in 9,fair in 1,poor in 1;in parastyle reduction group,the results were excellent in 9 patients,good in 11,fair in 6,poor in 2（u=0.613,P0.05）. Conclusion：Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome is a feasible methed for the recovery of hip joint function.