复杂髋臼骨折手术疗效的相关因素研究

Analysis of the influencing factors of operative effect in complex acetabular fracture

目的探讨影响复杂髋臼骨折手术疗效的相关因素。方法选取67例复杂髋臼骨折患者。所有患者均进行手术治疗，临床疗效按Merle d＇Aubigne—Postel髋关节功能评分标准进行评估，设定年龄、性别、手术时机、手术入路方式、骨折复位质量、是否有髋关节脱位和复杂骨折类型为对比指标。结果术后随访6—24个月，平均14．6个月。患者手术时机中≤2周手术者优良率[84．0％（42／50）]明显高于〉2周手术者[64．7％（11／17）]（P〈0．05），骨折复位质量中解剖复位的患者优良率[86．4％（19/22）]明显高于不满意复位的患者[44．4％（4／9）]（P〈0．01）。患者年龄、性别、手术入路方式以及有无髋关节脱位情况比较差异均无统计学意义（P〉0．05）。复杂髋臼骨折各类型优良率对比可见，T形骨折的优良率为85．7％（12／14），显著高于后柱伴后壁骨折[77．8％（7／9）]、横形伴后壁骨折[75．0％（15／20）]、前柱伴后半横形骨折[66．7％（2/3）]、双柱骨折[71．4％（15／21）]。结论保证骨折预后的必要条件是骨折复位质量、手术时机以及复杂骨折类型。

Objective To investigate the influence factors of operative effect in complex acetabular fracture. Methods Sixty-seven patients with complex acetabular fractures were selected. All patients were used surgical treatment,the clinical curative effect by Merle d＇Aubigne-Postel hip scoring function to evaluate,set the age,sex, operation time,operative approach,the quality of fracture reduction,complex dislocation of the hip fracture and type of complex acetabular fractures with comparative index,the results were statistically analyzed. Results Patients were followed up for 6-24 months,the mean time was 14.6 months. Univariate analysis showed that the fine efficacy of surgery taken in no more than 2 weeks [ 84.0% （42/50） ] was better than more than 2 weeks [ 64.7% （11/17） ] （P 〈 0.05）. The high-quality of reduction [ 86.4% （19/22） ] was better than low -quality of reduction [ 44.4% （4/9） ] （ P 〈 0.01 ）. The compare of age, sex,operative approach,complex dislocation of the hip fracture were no statistically different （P 〉0.05）. Complex acetabular fractures of T-shaped fracture healing rate was 85.7% （12/14）,the excellent rate was significantly higher than posterior column with posterior wall fractures [77.8% （7/9）],transverse with posterior wall fractures [ 75.0%（ 15/20 ） ], anterior column with half of transverse fractures [ 66.7%（2/3 ） ], double-column fractures [71.4% （15/21）],the results were statistically different. Conclusion The necessary conditions for ensuring fracture prognosis is the quality of reduction, timing of surgery, and type of fracture.