髋臼后壁骨折的手术治疗及疗效分析

The operative treatment and clinical effect of posterior wall fractures of the acetabulum

目的探讨髋臼后壁骨折的诊断及治疗方法,评价临床疗效。方法手术治疗32例髋臼后壁骨折患者。术后复位质量和X线片随访疗效均按Matta标准评定。异位骨化采用Brooker分级法评估。结果 32例均获随访,时间1-4（2.4±1.5）年。解剖复位者25例,满意复位者6例,不满意复位者1例。根据Matta评定标准：优17例,良8例,可4例,差3例。4例发生异位骨化,按Brooker分级：Ⅰ级3例,Ⅱ级1例;3例发生骨性关节炎;无感染、股骨头坏死或下肢深静脉血栓和肺栓塞等并发症发生。结论髋臼后壁骨折患者采用X线片、CT平扫和三维重建等检查能获得早期诊断。早期切开解剖复位和坚强内固定、延期负重锻炼,可获得满意的近期疗效。

Objective To discuss the operative treatment and clinical effect of posterior wall fractures of the acetabulum.Methods The operation was done on 32 patients who were suffered with posterior wall fractures of the acetabulum.The quality of fracture reduction after operation and the results of follow-up of operation and radiograph were assessed according to Matta′s standard.Ossification was assessed according to Brooker′s standard.Results All cases were followed-up for mean（2.4±1.5）years.According to Matta′s standard,17 cases were rated excellent,8 good,4 fair and 3 poor for operative result;25 cases were rated excellent,6 good and 1 in poor in radiographic results.3 cases were rated BrookerⅠ,1 case in BrookerⅡ for ossification.3 patients were complicated with posttraumatic arthritis,and no infection,femoral head necrosis and deep vein thrombosis were found.Conclusions It is necessary to operate posterior wall fractures of the acetabulum which is diagnosed correctly through integrating radiograph and CT with 3-D CT.Though the degree of fracture is severe,the early good results are obtained through anatomic reduction,rigid internal fixation and delayed exercise.