经单一Kocher—Langenbeck入路治疗复合髋臼骨折

Operative treatment of associated acetabular fractures via a single Kocher-Langenbeck approach

目的 评价经单一Kocher-Langenbeck入路治疗某些复合类型髋臼骨折的疗效并研究骨折复位质量与关节功能之间的关系.方法 对自1993年10月至2004年12月,通过单一KocherLangenbeck入路手术治疗的116例（117髋）复合类型髋臼骨折病例进行回顾性研究,80例（81髋）患者获得随访.其中T形骨折5髋,横形伴后壁骨折53髋,后柱伴后壁骨折18髋,双柱骨折4髋,前方伴后方半横形骨折1髋.评价患者术后的骨折复位质量,并对功能结果和并发症进行随访.结果 平均随诊51.7个月,手术后复位质量：解剖复位39髋,良好复位31髋,复位差11髋.髋关节功能：优25髋,良37髋,中13髋,差6髋,优良率为76.5%（62髋）.81髋骨折全部愈合,未发生感染,术后坐骨神经损伤5髋,异位骨化发生率为29.6%（24髋）,创伤性关节炎18髋（22.5%）,发生股骨头缺血坏死6髋.结论 髋臼骨折中,后柱伴后壁骨折、大多数横形伴后壁骨折及有些T形骨折、双柱骨折可以通过单一的Kocher-Langenbeck入路完成骨折的复位及内固定,手术中能达到解剖复位或接近解剖复位,术后功能良好.好的复位质量是取得良好功能的前提.

Objective To evaluate the operative outcome of associated acetabular fractures through single Kocher-Langenbeck （K-L） approach and investigate the relationship between the quality of fracture reduction and long-term joint function. Methods A total of 116 associated acetabular fractures were treated through single K-L approach at our department from October 1993 to December 2004. All cases were evaluated retrospectively. And 80 cases （81 hips） were followed up, including 5 hips of T-shaped fractures,53 hips of associated transverse and posterior wall factures, 18 hips of associated posterior column and posterior wall fractures, 4 hips of both column fractures and 1 hip of the associated anterior and posterior hemitransverse fractures. The quality of fracture reduction was evaluated. And the functional results and complications were tracked. Results The average duration of follow-up was 51.7 months. Anatomical reduction was achieved in 39, satisfactory in 31 and unsatisfactory reduction in 11 hips. The clinical outcome was excellent and good in 62 （ 76. 5% ） hips. All fractures were healed without infection. And 24 hips showed post-operative heterotopic ossification. The incidence of post-traumatic osteoarthritis was 22. 5% （ 18hips）. There were 5 hips with the palsies of sciatic nerve. And the avascular necrosis of femoral head was found in 6 hips. Conclusion Associated posterior column and posterior wall fractures, most transverse and posterior wall fractures, certain T shape fractures and both column fractures may be treated through a single K-L approach. Excellent reductions and satisfactory functional outcome can be achieved. The satisfactory joint function is based on a perfect fracture reduction.